United Hospital Fund Report: Children's Behavioral Health Reform Depends on Solving Implementation Challenges

 

NEW YORK—The United Hospital Fund today published a report that highlights four implementation challenges that must be solved as part of a successful redesign of behavioral health services for children in New York’s Medicaid program. The report is timely, given the ambitious set of Medicaid reform initiatives that New York State is pursuing to promote a shift away from a fee-for-service payment system and toward a system that supports care coordination and rewards value.

 

The challenges include the strengthening and modernization of the behavioral health workforce, the development of new health information technology capacities, forging effective managed care arrangements between providers and plans, and the creation of a more robust quality measurement system. The report also notes that implementing reform will require a substantial financial investment from the State.

 

Currently, there are approximately two million children in New York’s Medicaid program who are enrolled in managed care for their physical health services, yet services for their behavioral health needs are delivered largely under a fee-for-service model. In a given year, about 10 percent use behavioral health services. Responsibility for children’s behavioral health services is divided among an array of State and county agencies. Summarizing the challenges the State’s reforms aim to address, the report notes, “The bifurcation of managed care and fee-for-service…can lead to uncoordinated and fragmented care, as well as unmet needs for those wait-listed or ineligible for…services, and long waits for services such as day treatment and residential treatment facilities.”

 

The report provides an easy-to-understand overview of the complex structure of current services, as well as summarizing the needs of different special populations of children (e.g., children with serious emotional disturbances and children in foster care). It also presents a snapshot of behavioral health use by Medicaid-enrolled children, as well as a glossary of behavioral health services terms.

 

“In reform discussions, the special needs of children can get short shrift, which means important opportunities are missed,” said Elizabeth Patchias, senior health policy analyst in the Medicaid Institute at United Hospital Fund and the report’s author. “Because of the potentially lifelong impact of health care decisions involving a child, they are some of our most important.”

 

“The State’s vision for reforming children’s behavioral health services is solid, but that doesn’t mean it’s a simple vision to implement,” said Jim Tallon, president of the United Hospital Fund. “Our hope is that creating a digestible overview and identifying key challenges can help pave the way for these reforms.”

 

Redesigning Children’s Behavioral Health Services in New York’s Medicaid Program was prepared by Elizabeth Patchias. It is available at https://www.uhfnyc.org/publications/881078.