NAMD Acknowledges Cost Shifting

            I just reviewed the National Association of Medicaid Directors’ April 6 press release on the proposed MHPAEA CHIP/Medicaid rules (available here).  It is heartening to see NAMD’s recognition that Medicaid has “quietly become the largest payer of mental health services in the country, in part because other payers have been able to shift these costs onto the safety net.”

“Other payers” is of course just a nice way of saying “commercial managed care companies”, and “the safety net” is another way of saying “the public”.  Commercial managed care companies Other payers have been getting away with this cost shifting for years.  There are analytical tools that can capture many key components of the cost shifting that results from unlawful managed care conduct (a category that now includes MHPAEA violations), and there are readily available legal tools that would allow many public funders to recover those shifted costs from commercial managed care companies other payers.  Seems to us that any meaningful MHPAEA enforcement strategy would include consideration of these cost recovery tools.