This report addresses the reasons why people referred for behavioral health services from other agencies do not always receive these services. We found that several factors appear to cause such service denials. First, we found that disputes over the medical necessity of services and agency roles in serving clients with special needs often contribute to interagency disagreements. Second, some officials incorrectly believe some services, particularly substance abuse services, are not available to all entitled clients. Confusion also exists over whether clients referred by other agencies are actually enrolled in entitlement programs. Finally, services may not be rendered because some are simply unavailable, especially for disruptive clients or for clients living in rural areas. We offer several recommendations, ranging from clarifying existing policies to transferring the administration of behavioral health services for developmentally disabled ALTCS clients, to help diminish interagency disagreements and improve access to needed services.
This report also recommends that the Division of Behavioral Health Services play a greater role in providing treatment for Medicaid-eligible juvenile sex offenders on parole or probation, and Medicaid-eligible juveniles who are removed from prison for behavioral health treatment. Such a shift in service provision could help the State save money since Medicaid dollars are largely provided by the federal government.