Key Takeaways
- Specialty plans — in which managed care entities deliver integrated, tailored benefits for specific populations — are a state policy approach to align financing and administration in support of whole-person care.
- This brief examines design and evaluation considerations for states implementing specialty plan models within Medicaid, focusing on plan administration, eligibility, benefits, stakeholder engagement, and outcome measurement.
- While specialty plan approaches are relevant for a range of populations, this brief highlights five states — Arizona, Arkansas, Florida, New York, and North Carolina — that developed plans specifically for people with serious behavioral health conditions.
Medicaid specialty plans are a state policy approach used to align financing and administration in support of whole-person care, particularly for people with complex health needs. To improve outcomes for high-need populations, many states are using specialty plans as a way to deliver more coordinated services and tailored benefits. Behavioral health is one area where these plans have been especially valuable. Medicaid enrollees with serious behavioral health needs — including serious mental illness and substance use disorders (SUD) — often experience poor outcomes, with spending per enrollee four times higher than for those without a behavioral health diagnosis.
This brief, made possible by the California Health Care Foundation, examines design and evaluation considerations for states implementing specialty plan models within Medicaid — focusing on plan administration, eligibility, benefits, stakeholder engagement, and outcome measurement. While specialty plan approaches are relevant for a range of Medicaid populations, the brief highlights five states — Arizona, Arkansas, Florida, New York, and North Carolina — that developed plans specifically for Medicaid members with serious behavioral health conditions. The findings are informed by research and interviews with leaders from state Medicaid agencies, entities sponsoring these plans, and behavioral health providers.
