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 为身体和精神建立了医疗补助管理保健(MMC)计划 医疗服务。这一计划导致了该州精神上的不良影响 健康安全网，69个以社区为基础的项目关闭。2000年10月， 医疗保健融资管理局(HCFA)宣布不会续签 这项豁免允许州政府在MMC的领导下提供精神健康服务。 后来，它撤销了这一决定。然而，HCFA要求创建一个 由医疗补助接受者和提供者组成的咨询委员会，该委员会将 参与MMC下精神卫生服务的重新设计。 这一比较的、多地点的人种学项目将调查 对当前综合计划和未来医疗补助改革的规定 新墨西哥州的精神卫生服务，这个州主要是农村和 不同种族的人口。 为这个拟议的项目制定了两个具体目标：(1)评估 医疗补助改革对精神卫生安全网机构的影响 两个人口和文化截然不同的农村社区。是这样的 机构包括精神病院、住院治疗中心、日间医院 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 论获取障碍与文化知识的可获得性和感知质量 对盎格鲁人、西班牙人和美洲原住民的敏感心理健康护理 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访谈将被用来检查 该州医疗补助精神不断变化的社会和组织环境 卫生服务提供系统。这个项目的结果将澄清 医疗补助管理保健对可获得性、利用率、 历史上接受医疗补助的人的精神卫生保健和质量 新墨西哥州服务不足的多民族地区。该项目还将有助于 建立一个基线来分析未来的医疗补助改革，并 展示宏观层面的卫生政策如何影响安全网机构 为农村和边疆人群提供心理健康服务。

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 It later rescinded this decision.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.