Don't miss the great piece "Recent Changes in Medicaid Policy and Their Possible Effects on Mental Health Services” by Jeffrey A. Buck, Ph.D., Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, in the November issue of Psychiatric Services. If you were one of the few remaining people in the field who didn't think that Medicaid funding has come to indelibly change public mental health systems—and will continue to do so—this is a great synthesis of the current and future market effects.

On the system side, Dr. Buck identified the following Medicaid-driven system effects that have already occurred:

  • A larger role for state Medicaid authorities in state mental health services and a corresponding decline in the role of mental health authorities;

  • Service delivery privatization via Medicaid managed care arrangements which privatize many functions previously provided by public entities

  • Increased funding for community-based mental health care

  • Increased difficulty in using Medicaid funds for areas not clearly defined within the program;

  • Increased accountability of individual service providers via the Medicaid Integrity Program

  • Movement away from incentivizing psychiatric institutionalization

Dr. Buck also looks ahead to future policy changes. A few are ‘more of the same’—an increase in the role of Medicaid authorities and the growth of community-based services, with continued promotion of deinstitutionalization. In addition, he points to two other developments that are on the horizon. The first is increasing convergence of mental health policy with those that are the norm in primary care. The second is more meaningful consumer participation in treatment plan participation and choice of professionals and provider organizations.

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