The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update

In a primary behavioral health carve-out, a state Medicaid program delegates some or all behavioral health benefits to a separate management entity. In a secondary carve-out, Medicaid contracts with a health plan to manage all benefits, including behavioral health. The health plan then sub-contracts with another organization (a behavioral health care management organization) to manage behavioral health services. Management of behavioral health services can include provider organization credentialing, network management, prior authorization, and claims processing. Within the secondary carve-out, a health plan can either use a plan subsidiary to manage benefits or contract with an unrelated . . .