State Medicaid Managed Care and Access to Rural Behavioral Health Services
May 2022 / Eliza Mette and Jodi Manz
Most states deliver Medicaid behavioral health services through contracts with managed care organizations (MCO). Federal regulation requires that these contracts include network adequacy standards for specified provider types, including behavioral health providers. When developing network adequacy standards, states must consider anticipated Medicaid enrollment and service utilization; the volume and types of providers needed; the distance and travel time between network providers and Medicaid enrollees; and the physical accessibility of services, including through telemedicine.
Including these network adequacy requirements in managed care contracts helps states to ensure that all plan members have access to behavioral health care providers. In addition to a robust network of providers, states are also taking opportunities to enhance and build out access via telehealth. In rural and frontier areas, where networks can be more challenging to develop, this can be particularly helpful.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
