State agencies provide behavioral health services to children and youth with special health care needs (CYSHCN) in a variety of ways. For example, the Connecticut and Maryland Medicaid programs use Administrative Service Organizations (ASOs). In Connecticut, Medicaid has contracts with ASOs that manage different services, such as medical, dental, and behavioral health. The medical ASO identifies children eligible for the Intensive Care Management program (ICM), which is available to people of all ages. It uses predictive modeling and other measures to identify people with special health care needs and other at-risk groups who have co-morbid behavioral health conditions and who have a high level of service utilization. Medicaid provides intensive care management (ICM) to enrollees if the services are welcomed by the member. Much of the focus of the ICM program involves helping to mitigate the social determinants of health by also offering assistance with housing and food insecurity. In addition to services provided under the ICM program, Medicaid also provides separate payments to primary care providers for mental health, autism, developmental, and behavioral health screenings.
Maryland Medicaid contracts with an ASO to administer mental health and substance use disorder services under the state’s Public Behavioral Health System. The ASO collaborates with Medicaid and local jurisdictions to link children and adults with mental and behavioral health conditions to service providers. Maryland Medicaid also provides Therapeutic Behavioral Services (TBS), including a one-to-one behavior aide, to assist families in implementing a plan for children at risk of out-of-home placement. Additionally, Medicaid has implemented a 1915(i) waiver, which supports wraparound services for children with Serious Emotional Disturbance (SED) and serious mental illness. These services include peer support, respite, behavioral services, mobile crisis intervention, and intensive in-home services.
Louisiana’s Comprehensive Systems of Care (CSoC) is a managed care delivery model that provides specialized behavioral health services for children with SED who are enrolled in Medicaid. It includes a 1915(b)(3) and 1915 (c) waiver for the care of children and youth under age 22 who are at risk of out-of-home placement.
The Children’s Behavioral Health Initiative (CBHI) is the Massachusetts MassHealth (Medicaid) program’s statewide, community-based system of care for children and youth with significant mental health needs. In 2007, the state added six services to its State Plan, including Intensive Care Coordination, using high fidelity wraparound as a Targeted Case Management Service for children with SED. All of the Medicaid Managed Care Organizations who serve the under 21 population manage this specialized network of providers in a collaborative manner. The Initiative has also brought pediatrics and children’s mental health into closer dialogue with the implementation of universal, standardized behavioral health screening in the primary care setting for MassHealth members under 21.
In New Hampshire, behavioral health supports are provided through a joint contract between the Bureau of Developmental Services (BDS) and Special Medical Services (SMS), the New Hampshire Title V/CSHCN program. These two agencies support a psychiatrist for two days a week, based at the Dartmouth Hitchcock Medical Center’s Department of Psychiatry. The two state agencies can each refer children for consultation and evaluation, medication review, and any other concern related to mental health. This is particularly helpful for children who have both mental health and chronic physical conditions. The purpose of this initiative is to serve underserved populations and address the lack of child psychiatrists in the state by supplementing the care provided by the child’s primary care physician.