Collaborative Governance in the Age of Managed Behavioral Health Care

Objective: Collaborative governance engages public and private stakeholders in shared decision-making. In this article, we investigate New York State's Regional Planning Consortiums (RPCs), a collaborative governance model designed to monitor the transition of the state's public behavioral health system to Medicaid managed care. We use an integrative framework to examine how officials believed collaborative governance would address policy challenges in the system context. By distinguishing between features of the state's program that were consistent with and different from past studies, we identify how collaborative governance is evolving to address perceived threats to democratic institutions and how it might indirectly contribute to their unmooring. Method: We conducted semistructured interviews with 30 state- and county-level behavioral health officials and quasi-governmental personnel. Data were analyzed using grounded theory methods. Results: Informants identified the drivers of the RPCs, which included challenges related to privatization of service administration and centralization of government. They said they expected the collaborative governance regime to attenuate these hazards by involving affected stakeholder groups in shared decision-making, placing local officials in leadership positions, and developing a regional monitoring system to track adverse impacts. Informants also said they anticipated that collaboration dynamics would improve behavioral health policymaking and enhance the effectiveness of services. Some informants were reluctant to fully embrace the aspirations of collaborative governance, believing it would indirectly contribute to a reduced role for government in public administration and undermine democratic norms, especially at the local level. Conclusions: This study describes how collaborative governance is changing under advanced liberalism. It highlights opportunities and limitations of collaborative governance that are important for public policymakers and scholars of social work, social welfare, and behavioral health to understand.