Dataset Information

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

ABSTRACT: BACKGROUND:The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. OBJECTIVE:The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. RESEARCH DESIGN:We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. MEASURES:Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. RESULTS:We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. CONCLUSIONS:Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.

SUBMITTER: Bodurtha PJ

PROVIDER: S-EPMC7045703 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

Bodurtha Peter J PJ Winkelman Tyler T Vickery Katherine D KD Owen Ross R Van Siclen Renee R Erickson Erik E Hougham Courtney C Legler Mark M Jennings Latasha L Shippee Nathan N

Medical care 20190201 2

<h4>Background</h4>The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors.<h4>Objective</h4>The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees.<h4>Research design</h4>We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees ...[more]

PMID: 30461582

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Project description:ImportanceAdministrative records indicate that more than half of the 80 million Medicaid enrollees identify as belonging to a racial and ethnic minority group. Despite this, disparities within the Medicaid program remain understudied. For example, we know of no studies examining racial differences in Medicaid spending, a potential measure of how equitably state resources are allocated.ObjectivesTo examine whether and to what extent there are differences in health care spending and utilization between Black and White enrollees in Medicaid.Design setting and participantsThis cross-sectional study used calendar year 2016 administrative data from 3 state Medicaid programs and included 1 966 689 Black and White Medicaid enrollees. Analyses were performed between January 28, 2021, and October 18, 2021.ExposuresSelf-reported race.Main outcomes and measuresRates and racial differences in health care spending and utilization (including Healthcare Effectiveness Data and Information Set [HEDIS] access measures).ResultsOf 1 966 689 Medicaid adults and children (mean [SD] age, 20.3 [17.1] years; 1 119 136 [56.9%] female), 867 183 (44.1%) self-identified as non-Hispanic Black and 1 099 506 (55.9%) self-identified as non-Hispanic White. Results were adjusted for age, sex, Medicaid eligibility category, zip code, health status, and usual source of care. On average, annual spending on Black adult (19 years or older) Medicaid enrollees was $317 (95% CI, $259-$375) lower than White enrollees, a 6% difference. Among children (18 years or younger), annual spending on Black enrollees was $256 (14%) lower (95% CI, $222-$290). Adult Black enrollees also had 19.3 (95% CI, 16.78-21.84), or 4%, fewer primary care encounters per 100 enrollees per year compared with White enrollees. Among children, the differences in primary care utilization were larger: Black enrollees had 90.1 (95% CI, 88.2-91.8) fewer primary care encounters per 100 enrollees per year compared with White enrollees, a 23% difference. Black enrollees had lower utilization of most other services, including high-value prescription drugs, but higher emergency department use and rates of HEDIS preventive screenings.Conclusions and relevanceIn this cross-sectional study of US Medicaid enrollees in 3 states, Black enrollees generated lower spending and used fewer services, including primary care and recommended care for acute and chronic conditions, but had substantially higher emergency department use. While Black enrollees had higher rates of HEDIS preventive screenings, ensuring equitable access to all services in Medicaid must remain a national priority.

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Dataset Information

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

Publications

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

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