The Medicaid Vertical Carve-Out Model Comes To I/DD

A couple of weeks ago, I wrote about our new analysis of Medicaid behavioral health carve-outs. These primary "horizontal" carve-outs are on the decline in Medicaid – nine states have primary carve-outs to care management organizations (CMOs) compared to 13 states in 2011. This change is driven by a policy preference for "integration" and "whole person care" models (see Do States Still Have Medicaid Behavioral Health Carve-Outs?).

At the same time, we're seeing an increase in the "vertical carve-out" model in Medicaid. Under a vertical carve-out, the state Medicaid program delegates responsibility for all . . .