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.

PROJECT NARRATIVE / PUBLIC HEALTH SIGNIFICANCE This project will examine behavioral health integration in community health centers and its association with outcomes for Medicaid enrollees with mental illness. This is important because CHCs provide care for 15 million Medicaid enrollees annually and have been critical partners for Medicaid payment and delivery reforms, including medical homes and care management programs. Understanding the current national landscape of behavioral health integration, its consequences for access to care, patient outcomes, and equity, as well as the factors that may facilitate or hinder integration in health centers will provide actionable information to policy makers to better target resources to reduce costs and improve outcomes for individuals with mental health disorders.