In 1992 Georgia embarked on an ambitious reform of its public mental
health system. Regional mental health authorities were created with
consumers and family members as decision makers. Reform legislation
required that hospital and community funds be combined to provide for
flexible shifting of funds to communities as use of state hospitals
decreased. However, after four years and at a cost of almost $15 million,
few tangible results can be demonstrated. In fact, hospital admissions have
increased since 1991. Further, a proposal for a Medicaid section 1115
waiver that would permit managed care organizations to assume
responsibility for key decisions threatens to undermine the decision-making
authority of regional mental health authorities. This paper summarizes the
background leading to Georgia's reform, reviews its accomplishments, and
suggests lessons to be gained from Georgia's experiences.
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