Is Conventional Wisdom Wrong?

Conventional wisdom suggests that coverage for substance abuse treatment under Medicaid is generally poor, and that access to care may be reduced when control over behavioral health services is given to private health plans, such as those under Medicaid managed care. To examine this premise, this study reports on a cross-sectional comparative survey of state Medicaid managed care programs conducted in the year 2000. Although not all states provided substance abuse benefits under their Medicaid programs, our findings suggest that a majority of states used managed care arrangements to provide substance abuse treatment, with most providing an array of covered services. Most Medicaid behavioral health plans were fully capitated. The number of comprehensive health plans providing substance abuse services was slightly higher than the number of behavioral health carveouts. About half of the waiver programs that covered substance abuse treatment covered methadone maintenance, but waiver programs employing comprehensive health plans were more likely to provide coverage for methadone maintenance.