OPEN MINDS Releases Full List Of 2017 Medicaid Health Plan Secondary Carve-Outs & Financial Arrangements

Recent Market Intelligence Report provides complete listing of all Medicaid health plan carve-outs & carve-out organizations

Gettysburg, Pa. (April 30, 2017) — Today Medicaid managed care is nearly ubiquitous – 38 state Medicaid programs are operating at least one health plan and 69% of Medicaid beneficiaries are enrolled in a comprehensive managed care plan. This, coupled with the move to value-based purchasing both at the state level and the individual health plan level, has made negotiating contracts with managed care plans even more important. With primary and secondary carve-outs making knowing who to contract with to provide behavioral health services extremely difficult, the OPEN MINDS Market Intelligence Team developed the recently released OPEN MINDS Market Intelligence Report, The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update, to provide readers with an in-depth analysis of behavioral health financing arrangements for Medicaid health plans – including a comprehensive list of Medicaid health plan carve-outs and carve-out organizations.

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.

During our analysis, our team found that there are 38 states with 312 health plans and more than 450 contracts to provide Medicaid managed care services. Of those 38 states, four (Maryland, New Jersey, Pennsylvania, and Utah) had primary behavioral health carve-outs where are all services except those provided in a primary care setting were excluded from the health plan’s capitation rate; These states were excluded from our analysis. Remaining were 34 states with 286 health plans and more than 400 contracts. Of these health plans, 40% (or 113) had a secondary carve-out and 60% (or 173) did not, instead using an internal unit or department for managing behavioral health services. Of those health plans with a secondary carve-out, 60% (or 68) had an external behavioral health vendor and 40% (or 45) had a subsidiary acting as the behavioral health vendor.

The OPEN MINDS Market Intelligence Report, The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update, provides a detailed state-by-state analysis on behavioral health financing arrangements for each health plan. Sections of the report include:

• An in-depth overview of the different types of carve-outs, including primary carve-outs, secondary carve-outs, and secondary carve-out sub-types.
• A strategic market landscape overview with key stats on the use of secondary carve-outs
• The number of lives covered under secondary carve-outs
• A state-by-state directory of the health plans with secondary carve-outs and their behavioral health organization

“In the 38 states with managed care, knowing who to contract with to provide behavioral health services can be extremely difficult. Executive teams need to understand how behavioral health services are financed – and while looking an global overview of the landscape may be helpful, it’s not enough,” said Athena Mandros, Market Intelligence Manager of OPEN MINDS. “Executive teams need is a tactical plan with health plan specific information in the states where they operate, which is why we provided this critical state-by-state guide describing behavioral health financing arrangements for each health plan. This analysis provides our readers with the information necessary to understand who to negotiate contracts with to provide services.”

For a detailed summary of the report, check out the article, Understanding The Medicaid Behavioral Health Carve-Out Map – Step One In Health Plan Contracting, which is available at no cost to the public.

The full report is available free to OPEN MINDS Premium and Elite members in The OPEN MINDS Circle Library: The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update

The full report can also be purchased in The OPEN MINDS e-store at: https://www.openminds.com/downloads/2017-medicaid-secondary-carve-market/

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OPEN MINDS is a national strategic advisory firm specializing in the sectors of the health and human service industry serving individuals with complex support needs: mental health; addiction treatment; children and family services; intellectual and developmental disabilities; chronic disease management; long term care; social services; correctional health care; and juvenile justice.

Founded in 1987 and based in Gettysburg, Pennsylvania, the 75+ associates believe by providing the latest market intelligence and management best practices to organizations serving the health and social support needs of the most vulnerable consumers, those organizations will be better able to provide efficient and effective services. Learn more at www.openminds.com.

For additional questions and inquiries, please contact Sarah Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or openminds@openminds.com.