ABSTRACT
Medicaid is the largest payer for mental health care in the US, providing coverage for more than a quarter of
those with serious mental illness. Yet, despite a greater burden of mental illness and more chronic physical
disease, Medicaid enrollees have especially high rates of unmet care needs due to low behavioral health
provider participation in Medicaid networks and fragmented payment and delivery systems. Community Health
Centers (CHCs) make up a critical component of the safety-net for low-income and underserved populations.
CHCs have been at the forefront of medical home demonstrations and have increasingly integrated behavioral
health services and personnel into comprehensive primary care practices. While a confluence of federal and
state policy initiatives, as well as efforts on behalf of advocacy groups and professional associations, have
prioritized initiatives to integrate behavioral health with primary care for Medicaid enrollees, uptake of
evidenced-based models has been hampered by administrative and payment hurdles. To date, little is known
about the extent of integrated behavioral health among CHCs, including which patients have access to
integrated services, how integration is associated with outcomes, and how policies like state Medicaid benefit
design may be promoting clinical integration in CHCs. The proposed study will leverage a novel practice-level
dataset collected by the research team linked to national Medicaid claims and a variety of publicly available
data sources to examine the drivers and consequences of integrated behavioral health in CHCs. We will field a
survey among a nationally representative sample of CHC delivery sites to assess the current landscape of
integrated behavioral health using a validated instrument, determine the organizational and state-policy factors
associated with greater integration in these settings, and assess the extent to which clinic-level integration
improves access to care, quality, and health spending for Medicaid enrollees with mental illness. Further we
will develop and disseminate a new claims-based measure of behavioral health integration that will efforts to
track integrated behavioral health in CHCs and permit future research and policy evaluation without the need
of surveying clinics directly. Through this work we seek to provide timely and generalizable data on how efforts
to integrate care in CHCs are delivering value for state Medicaid programs. We expect this work to inform
resource allocation and policy decision-making to enhance access to evidenced-based systems of care for
enrollees with mental illness.
