Behavioral Health Managed Care
New York State is moving Medicaid behavioral health services from a fee-for-service system into Managed Care. Medicaid Managed Care plans and Medicaid providers will work together with Medicaid enrollees to create a person-centered service system focused on recovery and on integrating physical and behavioral health to improve health outcomes. Person-centered means that providers listen to the person receiving care, that they help the person understand their choices, and that people can be in control of their own lives and recovery.
Governor Cuomo laid the foundation for these changes in 2011 by calling for "a fundamental restructuring of (the) Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure."
To meet these goals for people with mental health and/or substance use conditions, the Governor appointed a Medicaid Redesign Team (MRT) Behavioral Health Workgroup. The Workgroup developed these principles and recommendations for moving behavioral health services into managed care:
- Coordinated Care
- Integration of physical and behavioral health services
- Recovery oriented services
- Patient/consumer choice
- Protection of continuity of care
- Ensure adequate and comprehensive networks
- Tying payment to outcomes
- Track physical and behavioral health spending separately (firewall)
- Reinvest savings to improve services for behavioral health populations
- Address the unique needs of children, families and older adults
The Office of Mental Health (OMH) is working closely with the Department of Health (DOH) and Office of Alcoholism and Substance Abuse Services (OASAS) to make sure that the MRT's recommendations and principles guide the change to managed care.
Managed Care Timeline: Behavioral health managed care began for adults in New York City October 1, 2015. For adults in other areas of the state, behavioral health managed care will be begin July 1, 2016. The Children's implementation will begin January 2017.
Please contact OMH Managed Care with any questions, comments or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint Page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.