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Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural SettingsPacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
University of New Mexico, Albuquerque, New Mexico, USA
University of the Pacific, Stockton, California, USA Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.
Key Words: health care, access to • health care, rural • health policy • managed care • mental health and illness
Qualitative Health Research, Vol. 18, No. 9,
1231-1246 (2008) This article has been cited by other articles:
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