Issues in Medicaid policy and system transformation: recommendations from the President's Commission

Efforts to ensure that people with disabilities participate fully in their communities have raised awareness of current Medicaid policies that impede provision of best-practice mental health services. The author summarizes issues that were examined by the Medicaid Subcommittee of the President's New Freedom Commission and its recommendations in four areas: access, service delivery, service coordination, and quality. Because of Medicaid's substantial role as a payer for mental health services, more creative and flexible program policies can promote system transformation. Current eligibility rules and time-consuming procedures can inhibit timely access to Medicaid coverage for people with mental illness. Medicaid benefit plans may create financial incentives for maintaining more traditional but less effective models of care. Some policies impede states' ability to coordinate Medicaid funding with other sources of funding to create systems of community-based care. Medicaid does not provide specific requirements to ensure that individuals with depression are identified and offered informed choices about treatment through primary or specialty care providers. Action steps to address these and other issues include use of presumptive eligibility and parity, retention of coverage as enrollees enter the workplace, guidance to states on evidence-based practices and service coordination with other agencies, more flexible financing mechanisms, improved data collection and reporting, and enhanced integration of primary and mental health care.