Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

  • Xiaoling XiangEmail author
  • Randall Owen
  • F. L. Fredrik G. Langi
  • Kiyoshi Yamaki
  • Dale Mitchell
  • Tamar Heller
  • Amol Karmarkar
  • Dustin French
  • Neil Jordan
Original Article


This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.


Medicaid Managed care Behavioral health Mental health 



This research was funded by the following sources: National Institutes of Health, grant# R24 P2CHD065702, and K01HD086290; and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant # 90AR5019, #90RT5023-01-00, #90RT5020-01-00, and #90RT5026-01-00.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10488_2018_892_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 KB)


  1. Austin, P. C., & Stuart, E. A. (2015). Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in Medicine, 34(28), 3661–3679.CrossRefGoogle Scholar
  2. Bianconi, J. M., Mahler, J. M., & McFarland, B. H. (2006). Outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care. Administration and Policy in Mental Health, 33(4), 411–422.CrossRefGoogle Scholar
  3. Bindman, A. B., Chattopadhyay, A., Osmond, D., Huen, W., & Bacchetti, P. (2004). Preventing unnecessary hospitalizations in Medi-Cal: Comparing fee-for-service with managed care. California HealthCare Foundation. Retrieved from
  4. Bouchery, E., & Harwood, H. (2003). The Nebraska Medicaid managed behavioral health care initiative: Impacts on utilization, expenditures, and quality of care for mental health. The Journal of Behavioral Health Services & Research, 30(1), 93–108.CrossRefGoogle Scholar
  5. Callahan, J. J., Shepard, D. S., Beinecke, R. H., Larson, M. J., & Cavanaugh, D. (1995). Mental health/substance abuse treatment in managed care: The Massachusetts Medicaid experience. Health Affairs (Millwood), 14(3), 173–184.CrossRefGoogle Scholar
  6. Clark, R. E., Leung, Y. H., Lin, W., Little, F. C., O’Connell, E., O’Connor, D. M., … Browne, M. K. (2009). Twelve-month diagnosed prevalence of mental illness, substance use disorders, and medical comorbidity in Massachusetts Medicare and Medicaid members aged 55 and over. Clinical & Population Health Research. Retrieved from
  7. Department of Health & Human Services, Centers for Medicare & Medicaid Services. (2011). CMS Manual System. Pub 100-04 Medicare Claims Processing. Retrieved from
  8. Duggan, M., & Hayford, T. (2013). Has the shift to managed care reduced Medicaid expenditures? Evidence from state and local-level mandates. Journal of Policy Analysis and Management, 32(3), 505–535.CrossRefGoogle Scholar
  9. Gifford, K., Ellis, E., Edwards, B., Associates, A. LashbrookH. Management, Hinton, E., Antonisse, L., & Valentine, A. & Robin Rudowitz Kaiser Family Foundation (2017). Medicaid moving ahead in uncertain times: Resuls from a 50-state Medicaid Budget Survey for State Fiscal Years 2017 and 2018. Available at Accessed August 10, 2018.
  10. Heller, T., Owen, R., Mitchell, D., Eisenberg, Y., Wing, C., Bowers, A., … Viola, J. (2015). An independent evaluation of the integrated care program: Final report findings through the third year (FY14). Institute on Disability and Human Development, University of Illinois at Chicago. Retrieved from
  11. Hutchinson, A. B., & Foster, E. M. (2003). The effect of Medicaid managed care on mental health care for children: A review of the literature. Mental Health Services Research, 5(1), 39–54.CrossRefGoogle Scholar
  12. Jones, K., Huey, J. C., Jordan, N., Boothroyd, R. A., Ramoni-Perazzi, J., & Shern, D. L. (2006). Examination of the effects of financial risk on the formal treatment costs for a Medicaid population with psychiatric disabilities. Medical Care, 44(4), 320–327.CrossRefGoogle Scholar
  13. Kronick, R., & Welch, W. P. (2014). Measuring coding intensity in the Medicare Advantage program. Medicare & Medicaid Research Review. Retrieved from
  14. Kronick, R. G., Bella, M., & Gilmer, T. P. (2009). The faces of Medicaid III: Refining the portrait of people with multiple chronic conditions. Retrieved from
  15. Leff, H. S., Wieman, D. A., McFarland, B. H., Morrissey, J. P., Rothbard, A., Shern, D. L., … Allen, I. E. (2005). Assessment of Medicaid managed behavioral health care for persons with serious mental illness. Psychiatric Services, 56(10), 1245–1253.CrossRefGoogle Scholar
  16. Lewis, C., Lynch, H., & Johnston, B. (2003). Dental complaints in emergency departments: a national perspective. Annals of Emergency Medicine, 42(1), 93–99.CrossRefGoogle Scholar
  17. Marton, J., Yelowitz, A., & Talbert, J. C. (2014). A tale of two cities? The heterogeneous impact of Medicaid managed care. Journal of Health Economics, 36, 47–68.CrossRefGoogle Scholar
  18. Masland, M. C., Snowden, L. R., & Wallace, N. T. (2007). Assessment, authorization and access to medicaid managed mental health care. Administrationa and Policy in Mental Health, 34(6), 548–562.CrossRefGoogle Scholar
  19. National Committee for Quality Assurance. (2015). Mental health utilization: Number and percentage of members receiving the following mental health services during the measurement year: Any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED. Retrieved from
  20. Owen, R., Heller, T., & Bowers, A. (2016). Health services appraisal and the transition to Medicaid Managed Care from fee for service. Disability and Health Journal, 9(2), 239–247.CrossRefGoogle Scholar
  21. Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthe, J., … Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43(11), 1130–1139.CrossRefGoogle Scholar
  22. Satcher, D. S. (2000). Surgeon General’s report on oral health. Public Health Reports, 115(5), 489–490.CrossRefGoogle Scholar
  23. Smith, V. K., Gifford, K., Ellis, E., Edwards, B., Rudowitz, R., Hinton, E., … Valentine, A. (2016). Implementing coverage and payment initiatives: Results from a 50-state Medicaid budget survey for state fiscal years 2016 and 2017. Retrieved from
  24. Sturm, R. (1999). Cost and quality trends under managed care: Is there a learning curve in behavioral health carve-out plans? Journal of Health Economics, 18(5), 593–604.CrossRefGoogle Scholar
  25. The Lewin Group. (2009). Medicaid Managed Care cost savings—A synthesis of 24 studies. Working Paper 17236. Retrieved from
  26. Wooldridge, J. M. (2013). Introductory econometrics: A modern approach (5th ed.). Cincinnati: Southwestern College Publishing.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Michigan School of Social WorkAnn ArborUSA
  2. 2.Department of Disability and Human DevelopmentUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Division of Epidemiology and BiostatisticsUniversity of Illinois at Chicago School of Public HealthChicagoUSA
  4. 4.Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonUSA
  5. 5.Veterans Affairs Health Services Research and Development ServiceChicagoUSA
  6. 6.Department of OphthalmologyNorthwestern University Feinberg School of MedicineChicagoUSA
  7. 7.Department of Psychiatry & Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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