The proposed research seeks to evaluate the impact of an innovative approach to the financing and delivery of mental health care to Medicaid program beneficiaries in the State of Utah. Utah, under a waiver from the Health Care Financing Administration, has contracted with three community mental health centers (whose service areas include 52% of all Medicaid beneficiaries) to provide mental health services in return for capitated payments. The evaluation is structured as a quasi-experimental design, with non-contracting sites providing comparison groups for different aspects of the analysis. The analysis will assess both program-level and beneficiary-level outcomes of the demonstration. At the program level, it will analyze the impact of the demonstration on Medicaid and CMHC operations, service utilization rates for beneficiaries and Medicaid expenditures. At the beneficiary level, it will estimate the impact of the demonstration on health status, access, satisfaction, and utilization of services by a sample of Medicaid beneficiaries diagnosed as schizophrenic. The unit of analysis changes with the nature of the research question and is, at different times, the CMHC, the Medicaid beneficiary, the Medicaid program, and the individual treatment episode. A mix of qualitative and quantitative research methodologies are proposed, utilizing a variety of data sources including Medicaid and Medicare claims files, provider financial and utilization records, in-person interviews with Medicaid beneficiaries, and in-person interviews with mental health providers and Medicaid program officials. The research team has experience, acquired primarily through the evaluation of a waivered Medicaid demonstration in Minnesota and the RAND Health Insurance Experiment, with the proposed data collection and analytic approaches. The evaluation represents a collaborative effort of researchers at the University of Minnesota and University of Utah, and has the full support of the Division of Health Care Financing, Department of Health, State of Utah, which has already funded a baseline survey of schizophrenic Medicaid beneficiaries that is an essential component of the proposed research design.
