Chapter 2: MITA 2.0 and BH MITA

The Medicaid Information Technology Architecture (MITA) Framework has evolved since its initial inception and so has the Medicaid Enterprise. I have worked in multiple states and can see how Medicaid differed from state to state. But I have also seen the many similarities. A few years after the initial MITA 1.0 Framework was released, Centers for Medicare & Medicaid Services (CMS) released MITA 2.0. MITA 2.0 included more details than version 1.0 and included an expanded definition of the Medicaid Enterprise. They also developed the Behavioral Health (BH) MITA Framework. BH-MITA was developed as the result of a collaboration between CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA).

One of the concepts introduced in MITA was the expansion of the Medicaid Enterprise beyond the traditional business processes performed by the Medicaid Agency. Identifying how Medicaid interacts with external entities is a central theme in MITA, and the creation of the BH MITA Framework was the first attempt by CMS to do just that. I first was introduced to the BH-MITA Framework while working with the State of North Carolina. North Carolina upgraded their Medicaid systems, including their behavior health (i.e. developmental disability, mental health, and substance abuse services) systems, so they decided to include behavioral health as part of their MITA State Self-Assessment (SS-A).

While working on the North Carolina MITA SS-A, I learned there is quite a bit of overlap between the MITA business processes and the BH-MITA business processes.  Because of my background in social services, I had extensive knowledge about how consumers accessed behavior health services. However, I did not fully understand how behavior health services were funded or how policy was developed. MITA helped connect those dots for me. When I previously worked in social services, the demand for services by consumers was always a challenge due to the lack of funding. After working with BH-MITA, I soon realized that the funding sources for behavior health services are very different than Medicaid. While some services are covered by Medicaid, many behavior health services are funded through local government and grants. The implications of this are because local governments are not funded by open-ended grants, they can run out of funding for these services at any point in the year. So what happens to people who are having a mental health crisis or struggling with drug addiction when there is no money to help them? The more I learned about MITA, the more I began to see how complex our healthcare system is and the issues we are faced with each day.