State Unable to Ensure Medicaid Recipients Get Appropriate Specialized Behavioral Health Services

An evaluation of the State’s specialized behavioral health services for Medicaid recipients found that while spending has increased, individuals’ ability to obtain access has decreased. In their report, auditors concluded the Office of Behavioral Health (OBH) cannot always ensure Medicaid recipients receive comprehensive and appropriate specialized behavioral health services.

Among their findings, auditors noted that while expenditures for specialized behavioral health services increased from approximately $213 million in 2012 to $445 million in 2016, about $266 million of the 2016 expenditures were for psychosocial rehabilitation and community psychiatric support and treatment, which are not evidence-based services. In contrast, the number of people receiving two of the four Medicaid evidence-based services decreased after specialized behavioral health services were moved into managed care. Evidence-based services have been shown to produce positive outcomes and reduce costs.

In addition, the managed care organizations (MCOs) that oversee the State’s Medicaid program reported that only 7.4 percent of individuals served by case management had a behavioral health diagnosis. Case management services help ensure individuals receive appropriate and coordinated care. The MCOs also are required to make community-based specialized behavioral health services available as much as possible to reduce the use of emergency rooms and eliminate preventable hospital admissions. However, there are not enough accessible community-based services in Louisiana to meet the need.

Auditors further found that Louisiana’s two state psychiatric hospitals only serve adults. There are no state psychiatric hospitals for adolescent and youth populations. In addition, the closure of state psychiatric hospitals and a decrease in the number of funded long-term beds has resulted in longer waiting lists for those who need more restrictive care. For instance, the waiting list at Central Louisiana State Hospital increased from 62 in June 2016 to 79 in February 2017, while the number of beds decreased from 354 in 2012 to 225 in 2016.

Individuals with behavioral health needs in nursing facilities and prisons also are not always receiving needed services. For example, of the 4,084 individuals with a primary behavioral health diagnosis in nursing facilities, 49 percent did not receive any specialized behavioral health services.

Budget cuts also have affected the State’s ability to provide comprehensive and appropriate specialized behavioral health services. Reduced funding has resulted in service gaps and in a lack of data integration among providers, which contributes to fragmented care.

This report is the second one the Legislative Auditor’s office has released on specialized behavioral health services for Medicaid recipients. The first one, which was released in October 2017, found OBH needed to strengthen its monitoring processes to ensure there are enough qualified specialized behavioral health providers for Medicaid recipients.