Am J Psychiatry 1982; 139:466-470
Copyright © 1982 by American Psychiatric Association
Medicaid cutbacks and block grants: crisis or opportunity for community mental health?
SS Sharfstein
The fourfold growth in the mental health service system since 1955 has been
largely financed by federal monies and by federal and state funding through
Medicaid. This growth represents expansion of both institutional and
outpatient settings, even though there has been a total reversal of the
proportion of inpatient to outpatient care over the last 22 years. Current
proposals to cap Medicaid costs and to issue block grants challenge the
delivery system to attempt alternatives, such as financing similar to what
is done in a health maintenance organization (HMO). The author describes a
model of a "mental health HMO" that would be appropriate from professional
consumer, and economic perspectives.
