Concurrent access to mental health and substance abuse services for medicaid clients in publicly funded treatment systems

Medicaid clients with co-occurring mental health and substance abuse problems comprise substantial portions of the clienteles served by public sector mental health and chemical dependency treatment systems. However, little is known about implications of managed care for "dual diagnosis" Medicaid clients. This prospective study conducted in eight states used interviews to examine managed care impact on use of mental health services by adult Medicaid clients in treatment for substance abuse (N = 2,424) and on use of chemical dependency services by Medicaid clients with severe mental illness (N = 2,318). Compared with fee for service, managed care had no impact on use of mental health services by clients entering substance abuse treatment. Conversely, there was an apparent 26% reduction in substance abuse treatment (p < .02) among managed care (versus fee for service) Medicaid clients with severe mental illness. Managed care impact may vary among Medicaid sub-groups.