Public report analyzes Mississippi mental health spending

JACKSON — A report commissioned by the Mississippi Department of Mental Health confirms federal findings that the state has spent more on institutional care than community-based services for people with mental disabilities.

The state released the report Saturday after settlement with The Clarion-Ledger . The newspaper fought a legal battle for public disclosure of the $300,000 taxpayer-funded document.

The report found institutional treatment has made up "a disproportionately large share" of spending.

The Technical Assistance Collaborative is a Boston-based nonprofit group hired by the state. It analyzed Medicaid fee-for-service information for budget years 2010 through 2014; and managed care information for 2013 and 2014.

"It is concerning that spending and utilization of institutional care have increased over the past few years," the report said. "Mississippi has the opportunity to serve many more youth in less restrictive and more integrated settings by promoting greater use of services, such as mobile crisis intervention, crisis stabilization, intensive outpatient program ... and peer support. More effective use of these services could help divert youth from placement in costly institutional settings."

The report said use and spending trends for home- and community-based services "are largely in the right direction," but more work is needed to promote those services.

In the 2014 budget year, Mississippi Medicaid spent $184.4 million on children and youth behavior services. Other study findings:

Forty-nine percent of Medicaid child behavioral health dollars in 2014 were spent on services in institutional settings. Nationally,

in 2008, 28.3 percent of child behavioral health dollars spent by Medicaid were spent on inpatient or psychiatric residential services.

Spending for psychiatric residential treatment facilities and inpatient psychiatric hospitals increased by 11 percent and 6 percent, respectively, from 2010 to 2014.

Among the institutional services, inpatient psychiatric hospitals experienced the greatest increases in the number of unduplicated utilizers. There was an increase of about 22 percent in the number of young people in inpatient psychiatric hospitals from 2010 to 2014.

In 2010, there was a 10 percent increase of young people in psychiatric residential treatment facilities. Utilization remained steady from 2011 to 2014.

Findings related to home- and communitybased utilization and expenditures included:

More than $1 million in a given year was spent on assessment, community support, day treatment, individual therapy, intensive home-based treatment and targeted case management; while less than $1 million in a given year was spent on services such as mobile crisis, crisis residential, peer support and intensive outpatient.

Despite declines in day treatment utilization, nearly a quarter of home and community-based services money was spent on day treatment.

There was a 64 percent increase in spending on intensive home-based treatment from 2010 to 2014, with declines from 2013 to 2014, despite increases in claims and utilizers.

In 2014, claims for crisis services totaled almost $1 million.