Medicaid Managed Care for MH Services in Rural Settings

描述（申请人提供）：1997年7月，新墨西哥州 建立了医疗补助管理式护理（MMC）计划， 保健服务这一计划导致了国家的精神上的不利影响， 卫生安全网，因为69个基于社区的方案关闭。2000年10月， 卫生保健融资管理局（HCFA）宣布， 允许州政府根据MMC提供心理健康服务的豁免。 法院后来撤销了这一决定。然而，HCFA要求建立一个 由医疗补助接受者和提供者组成的咨询委员会， 参与重新设计MMC下的精神卫生服务。 这个比较性的、多地点的人种学项目将调查 目前的综合计划和未来的医疗补助改革的规定， 在新墨西哥州，一个以农村为主的州， 种族多样的人口。 本拟议项目的两个具体目标是：（1）评估 医疗补助改革对心理健康安全网机构和 两个在人口和文化上截然不同的农村社区。等 这些机构包括精神病医院、住院治疗中心、日间 治疗和部分住院计划，门诊治疗设置， 和初级保健提供者办公室。(2)评估医疗补助改革的效果 关于获取障碍以及文化知识的可得性和可感知质量的报告 敏感的精神卫生保健，以盎格鲁，西班牙裔，和美洲原住民 居住在这些社区的人口 定性数据收集技术的组合，包括参与者 观察和深入的，半结构化的采访，将被用来检查 不断变化的社会和组织背景下，国家的医疗补助精神 保健服务提供系统。该项目的结果将澄清 医疗补助管理式医疗对可及性、利用率 和精神卫生保健的质量为医疗补助受助人在历史上 新墨西哥州的多民族地区该项目还将为 建立一个基线，用于分析未来的医疗补助改革， 展示宏观层面的卫生政策如何影响安全网机构， 为农村和边境人口提供心理健康服务。

DESCRIPTION (provided by applicant): In July 1997, the State of New Mexico established a Medicaid managed care (MMC) Program for physical and mental health services. This program led to adverse effects in the state's mental health safety net, as 69 community-based programs closed. In October 2000, the Health Care Financing Administration (HCFA) announced that it would not renew the waiver that allowed the state to provide mental health services under MMC. It later rescinded this decision. However, HCFA has required the creation of an advisory committee comprised of Medicaid recipients and providers, which is to participate in the redesign of mental health services under MMC. This comparative, multi-site ethnographic project will investigate the effects of the current integrated program and future Medicaid reform on the provision of mental health services in New Mexico, a state with a predominately rural and ethnically diverse population. Two specific aims have been developed for this proposed project: (1) To assess the effects of Medicaid reform on mental health safety net institutions and on two demographically and culturally distinct rural communities. Such institutions include psychiatric hospitals, residential treatment centers, day treatment and partial hospitalization programs, outpatient treatment settings, and primary care provider offices. (2) To assess the effects of Medicaid reform on access barriers and the availability and perceived quality of culturally sensitive mental health care to the Anglo, Hispanic, and Native American populations that reside in these communities A combination of qualitative data collection techniques, including participant observation and in-depth, semi-structured interviewing, will be used to examine the changing social and organizational contexts of the state's Medicaid mental health services delivery system. The results of this project will clarify the differential influence of Medicaid managed care on accessibility, utilization, and quality of mental health care for Medicaid recipients in historically underserved, multiethnic regions of New Mexico. This project also will serve to establish a baseline against which to analyze future Medicaid reform and to demonstrate how macro-level health policy impacts safety net institutions that provide mental health services to rural and frontier populations.