State Mental Health Policy: New Mexico's Medicaid Managed Care Waiver: Organizing Input From Mental Health Consumers and Advocates
Year: 2003
Type: article
Abstract: The extensive literature on Medicaid gives scant attention to the role of public input in state officials' decisions to include vulnerable populations in Medicaid managed care programs.Evaluations of public health initiatives suggest that community input can be vital to a program's effectiveness and success (1).Section 1915(b) waivers allow states to require that Medicaid recipients enroll in capitated managed care programs.Under the Balanced Budget Act of 1997, states seeking to enroll vulnerable populations, including seriously mentally ill individuals, must obtain waivers.National advocacy groups support this requirement, because it ensures federal scrutiny of managed care systems originally designed for healthier clienteles (2).Thirty-five states currently operate 77 1915(b) waivers (3), which must be approved by the Centers for Medicare and Medicaid Services (CMS) and renewed at two-year intervals.Federal regulations do not specify how consumers of mental health services, patient advocates, and providers are to be involved in the development, evaluation, and renewal of waiver programs (4).Each state determines the extent of public involvement in these three areas.Involvement can take several forms, such as including community stakeholders in advisory bodies, soliciting their concerns in public forums, and incorporating their comments in waiver proposals.Nevertheless, public participation in the design and renewal of waiver programs may not be systematic or ongoing (5).Several barriers inhibit sustained involvement of community stakeholders in system-level oversight roles, including lack of training, technical support, and compensation.We focus on events in New Mexico that illustrate how the absence of defined procedures for participation by community stakeholders in waiver renewals requires consumers, patient advocates, and providers to rely on their own resourcefulness, connections, and persistence to make their voices heard.New Mexico's waiver renewal has national relevance as a result of the increasing emphasis on state-level processes in decisions regarding waivers.The experience in New Mexico suggests the need to institutionalize formal structures for public consultation about waiver programs.
Source: Psychiatric Services
Institution: University of New Mexico
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2107615669