Anthem’s analysis of data from South Carolina’s behavioral health “carve-in” illustrates the benefits of integration through comprehensive Medicaid managed care plans. Positive outcomes include lower emergency room spending for behavioral health-related reasons, increased spending for certain prescription drugs for mental health conditions, and quality improvements.
Medicaid is one of the largest funding sources for mental health and substance use disorder treatment in the United States, with states taking different approaches to provide these benefits. Some states with managed care programs “carve-out” behavioral health services—enrolling beneficiaries in managed care for all other health benefits but providing behavioral health services separately.
However, states are increasingly moving away from carve-outs in favor of integrated approaches, or “carve-ins.” Beginning in 2016, South Carolina included in its Medicaid managed care contracts behavioral health services previously delivered via fee-for-service. This study used data from BlueChoice HealthPlan—one of the state’s Medicaid managed care organizations—to better understand the carve-in’s impact.
- Integrating behavioral health in Medicaid managed care
- South Carolina's behavioral health carve-in