Who leaves managed behavioral health care?

The growth of managed care and the possibility of biased enrollment and disenrollment rates have raised concerns about cost shifting. This article analyzes the duration of continuous enrollment in a managed behavioral health organization among members with and without behavioral health care utilization and among members with different mental health conditions. Eleven large employers with more than 250,000 members who are enrolled in managed behavioral health plans are studied. Compared to managed care 10 years ago, the rate of disenrollment among patients with depression appears to have dropped. Moreover, there appear few differences in disenrollment among users and nonusers of behavioral health services, except for employees for whom coverage is linked to job performance. However, patients with substance abuse problems or severe types of disorders are significantly more likely to disenroll than patients with less severe problems.