Impact of Medicaid managed mental health care on delivery of services in a rural state: an AMI perspective

In March 1995 Iowa implemented a statewide mental health carve-out program under a Medicaid Section 1915b waiver. A goal was to provide equal access across counties for Medicaid recipients by introducing a statewide network of service providers. Problems have included the contractor's authorizing only services considered medically necessary for persons with serious mental illness, who also need community supports; contractor staff's lack of knowledge about regional resources and the limited availability of community-based services in most rural areas; clients' difficulty in gaining access to the new system; denial of inpatient hospitalization; untimely provider payments; and lack of education for providers, consumers, and families.