Managed Care

Information on managed care for persons served by community mental health service programs (CMHSPs)

When did CMHSP managed care start?

October 1998

How will managed care change CMHSP services?

• CMHSPs will still offer the same kinds of services they always have.  They can also offer some new or different services.
• Managed care will change the way that CMHSPs get money to provide services.
• It will also change the way that CMHSPs manage services and pay their subcontractors.

Will CMHSPs get more money under managed care?

 No, but they should be able to use their money in more flexible ways that will help the money go further.

What if I want my services changed?

If you want your services to change, ask the CMHSP for a person/family-centered plan.  The plan will say what services you want and need. Services should be more what you want and need than they may have been in the past.

Will I have a CMHSP case manager or supports coordinator to help me?

Yes, if you want one.

Is managed care only for people who have Medicaid?

No.  CMHSP managed care is for people with Medicaid and other people who get CMHSP services.

Note: Children who are on the children's Medicaid waiver will not be in CMHSP managed care.

Do I have to enroll in CMHSP managed care?

No.  You will continue to get your health care from your Medicaid health plan.  If you are not in a Medicaid health plan, you can go to a doctor or other healthcare provider who is enrolled with Medicaid.

What if I have both Medicare and Medicaid?

You may go to your doctor or other health care provider for health services.  You may also go to any Medicare-enrolled health service provider for your Medicare-covered services.

You will go to your CMHSP for your Medicaid-covered mental health services.

Will there be waiting lists for CMHSP services under managed care?

People who need CMHSP services cannot be denied necessary services.  However, some services, such as residential, may not be available right away.

If you need a CMHSP service that is not available immediately, your CMHSP must offer you some services now.  They must also tell you when you can get the other services you need.

What if I have problems with my CMHSP or with the service I get?

If you have problems or do not like your services or your provider, you can file a grievance with your CMHSP.  Your CMHSP must tell you how to do that.

If you are denied entry in services by your CMHSP, you can ask the CMHSP director for a second opinion on that decision.

If you are a Medicaid recipient, you may also file a Medicaid appeal.  Your CMHSP must also tell you how to do that.  You can also call 1-888-858-5929 for information.

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