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The development of public-sector managed behavioral health care programs in the 1990s to serve Medicaid and other publicly financed populations represented a dramatic change in economic control and power within the behavioral health care system. Some have cogently argued that states make decisions regarding how to contract out (“carve out”) the management of such programs and which carve-out model to use based upon a complex consideration of strategic objectives within a political context. This paper argues that, on the contrary, it is changes in market power and political influence that drive states’ purchasing choices and subsequent decisions. (Authors)
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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration, Center for Mental Health Services