Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Susan Boser, Ph.D.

Second Advisor

Alex Heckert, Ph.D.

Third Advisor

Thomas Nowak, Ph.D.


The purpose of this study is to gather information about the organizational impact of Medicaid managed care on Community Behavioral Health Organizations (CBHOs). In particular, the study seeks to identify specific survival strategies utilized by CBHOs in light of the implementation of Medicaid managed care. It also seeks to determine if survival strategies have a positive effect on CBHO survival. The implementation of Medicaid managed care programs for mental health services is a relatively recent phenomenon, expanding into most states only in the late 1990s. However, the transition has been relatively rapid and 47 states had Medicaid managed care plans by 1998. Despite this dynamic change, there is very little comprehensive research about organizational behaviors in community behavioral healthcare organizations (CBHOs) since the implementation of Medicaid managed care, despite the fact that these organizations treat the vast majority of Medicaid mental health consumers, and rely on Medicaid reimbursement to survive. In addition, there are no organizational studies that link strategic changes to financial success. This research used financial data available from Guidestar and completed surveys from respondents in community behavioral healthcare organizations across the United States to analyze organizational changes. I used ordinary least squares multiple regression to estimate the impact of Medicaid managed care and other predictor variables on the implementation of survival strategies. I also used multiple regressions to determine the effect of survival strategies on gross revenue, the changes in gross revenue since 1998, net revenue, and the change in net revenue since 1998. The results of the research did not support the hypothesis in one case, in that Medicaid Managed Care did not appear to have a significant relationship to the use of survival strategies. However, I identified other predictor factors that had a weak to moderate effect on survival strategies. In addition, specific survival strategies had a positive effect on financial results. Further research should examine the reactions of community behavioral healthcare organizations to continued dynamic environmental change and the long-term effect of organizational change on financial success.