Medicaid is the largest payer for behavioral health services in the United States. Historically, Medicaid physical and behavioral health benefits have been managed and paid for separately, especially for people with serious behavioral health conditions. In recent years, however, state Medicaid agencies have started to integrate mental health and substance use disorder services into existing managed care programs. Referred to as carving-in behavioral health, or integrated managed care, this approach seeks to better coordinate care delivery for people with physical and behavioral health needs.
Carving-in behavioral health care can improve the quality and experience of care for patients, enhance care coordination and data-sharing among providers, and promote greater cost predictability for states. In the last 10 years, many states have transitioned from carving-out to carving-in behavioral health services, though approaches vary widely. This Better Care Playbook Evidence Roundup offers insight into the evidence base on carving-in behavioral health care into managed care and considerations for states interested in implementing this approach.