The Struggle To Provide Community-Based Care To Low-Income People With Serious Mental Illnesses

Cunningham, Peter; McKenzie, Kelly; Taylor, Erin Fries

doi:10.1377/hlthaff.25.3.694

Cited by 65 publications

(40 citation statements)

References 7 publications

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“…2 Problems with mental health care access are especially severe for low-income uninsured people and even some Medicaid enrollees, as public mental health services are seriously underfunded in many areas, and few private mental health care providers are willing to accept such patients. 3 Nevertheless, reasons for the underuse of mental health services are not well understood. In this regard, the perspective of primary care physicians (PCPs) would be helpful in understanding the health system barriers that patients encounter in gaining access to specialized mental health services.…”

mentioning

confidence: 99%

Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

2009

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confidence: 99%

Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

2009

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“…Although most SNIs, such as federally qualified health centers, accept clients with private insurance, such clients usually compose a minority of the clientele. Compared to their urban counterparts, rural SNIs are especially dependent on revenues from public insurance programs such as Medicaid despite their historically low reimbursement rates (Cunningham, McKenzie, & Taylor, 2006;Ormond et al, 2000).…”

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confidence: 99%

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

2008

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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.

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“…Because one-third of the county's adult psychiatric patients were not covered by MedCal; 22 we were not able to examine quality of care among another population of concern, uninsured persons with serious mental illness. 23 …”

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confidence: 99%

Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness

et al. 2009

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Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

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The Struggle To Provide Community-Based Care To Low-Income People With Serious Mental Illnesses

Abstract: This paper describes gaps in services for low-income people with serious

Cited by 65 publications

References 7 publications

Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness

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