The Commission is continuing its examination of behavioral health services for Medicaid-enrolled children and youth with behavioral and co-occurring health needs. The first phase of work examined appropriate access to residential treatment and resulted in chapters in MACPAC’s June 2025 and June 2026 reports to Congress. The second phase focuses on access to five intensive community-based behavioral health services that prevent the inappropriate use of residential treatment: intensive care coordination or targeted case management, high-fidelity wraparound, mobile crisis response, crisis stabilization, and respite. In April 2026, staff presented findings from federal and state policy scans.
In this session, staff presented findings from an analysis of Transformed Medicaid Statistical Information System (T-MSIS) data on use of these services and from interviews with federal and state officials, managed care organizations, advocates, and national experts. Interview findings address how states use existing authorities to cover these services, challenges with respite coverage, care coordination, provider capacity and payment, and reliance on residential treatment. MACPAC found that although states have flexibility to cover these services, access also depends on coordination, provider capacity, and stable financing.