Improving Treatment for Medicaid Beneficiaries with Co-Occurring Disorders

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Project Summary:

Epidemiologic data suggest that the prevalence of co-occurring mental illness and substance abuse is higher among Medicaid beneficiaries than in the general population. Co-occurring disorders have many negative outcomes, are under-diagnosed, and are treated inadequately. Improved treatment of Medicaid recipients with co-occurring disorders is a critical need. Yet there is little information on treatment rates and costs and other characteristics of Medicaid beneficiaries with dual disorders. Building on the New Hampshire study funded by the Substance Abuse Policy Research Program, this project will describe the characteristics, patterns of service use, and costs of Medicaid beneficiaries with co-occurring disorders from six ethnically diverse states located in various regions of the United States. We will then evaluate intervention strategies and make recommendations for improving treatment. The project’s specific aims are to 1. describe the prevalence of diagnosed co-occurring disorders and their impact on state Medicaid programs, emphasizing the needs of specific diagnostic, demographic, and eligibility sub-populations; the health care settings in which they present; and differences between those enrolled in managed care and traditional fee-for-service plans; 2. develop a set of policy recommendations, based on these analyses, that states can use to improve the efficiency and effectiveness of services for persons with co-occurring disorders. We will use 1997 and 1998 State Medicaid Research Files (SMRF) and 1999 Medicaid Analytic Extract (MAX) files from Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington to describe the diverse characteristics of Medicaid beneficiaries with co-occurring disorders, the settings in which they present, and the services they use. We will also compare Medicaid payments and rates of medical comorbidities for people with co-occurring disorders to those with only a psychiatric or a substance use disorder. Service use, including treatment settings, will be tracked for up to three years. Finally, we will examine associations between managed care plans and service use within eligibility groups. Using results of the claims analysis as a guide, we will evaluate the evidence for existing screening and treatment interventions. We will assess barriers to be removed and supports necessary for implementing the most promising intervention(s) for specific combinations of treatment settings and population characteristics. With assistance from a team of expert consultants, we will then develop recommendations that state agencies and treatment providers can use to improve care for co-occurring disorders among Medicaid beneficiaries. Final products will include a paper describing the characteristics of Medicaid beneficiaries with co-occurring disorders, including differences in diagnosed prevalence across eligibility, ethnic, gender, and age groups; access to appropriate care; and differences in total Medicaid payments compared with others in the same diagnostic groups without a substance use disorder. A second paper describing recommendations for improving treatment will be prepared for publication, and a final report will be developed for distribution to policy-makers and treatment providers.