Traditional, 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.

At the same time, there is an increase in the "vertical carve-out" model in Medicaid. Under a vertical carve-out, the state Medicaid program delegates responsibility for all benefits (physical health and behavioral health) for consumers with behavioral health disorders—or other specific disorders or needs—to a specialty CMO. Examples of populations served by this . . .

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