0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Medicaid Lapses and Low-Income Young Adults’ Receipt of Outpatient Mental Health Care After an Inpatient Stay
Eric P. Slade, Ph.D.; Lawrence S. Wissow, M.D., M.P.H.; Maryann Davis, Ph.D.; Michael T. Abrams, M.P.H.; Lisa B. Dixon, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200375
View Author and Article Information

Dr. Slade is with the Capitol Healthcare Network (VISN5) Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, and with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore (e-mail: eslade@psych.umaryland.edu). Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Davis is with the Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center, Systems and Psychosocial Advances Research Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester. Mr. Abrams is with the HillTop Institute, University of Maryland Baltimore County. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, and with the New York State Psychiatric Institute, New York City.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study examined low-income young adults’ use of outpatient mental health services after an inpatient mental health stay, with a focus on Medicaid enrollment lapses and public mental health safety-net coverage.

Methods  The sample included 1,174 young adults ages 18 to 26 who had been discharged from inpatient psychiatric care in a mid-Atlantic state. All were enrolled in Medicaid at the time of discharge, and all were eligible for continued outpatient public mental health services regardless of Medicaid enrollment. Administrative claims data were used to examine outpatient mental health clinic use, psychotropic medication possession, inpatient readmission, and emergency department admission during the 365-day period after the index discharge. The main independent variable was a lapse in Medicaid enrollment. An instrumental-variables regression model was used to minimize estimation bias resulting from unmeasured confounding between lapses and service use.

Results  Nearly a third (30%) of the young adults had an enrollment lapse. In instrumental-variables analysis, those whose coverage lapsed were less likely than those who had continuous Medicaid coverage to have at least two clinic visits (38% versus 80%); they also had a lower average psychotropic medication possession ratio (25% versus 55%).

Conclusions  Age-related Medicaid enrollment lapses were common in this sample of young adults and were associated with receipt of less clinical care postdischarge despite continued eligibility for public services. States should examine opportunities to assist young adults with serious mental health problems who are aging out of Medicaid enrollment categories for children.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Characteristics of 1,174 Medicaid enrollees ages 18 to 26, by whether they had an enrollment lapse
Table Footer Note

a Proportional and mean differences between lapse and no lapse groups were tested with an F test (df=1 and 1,173).

Anchor for Jump
Table 2Mental health service use in the 365 days after hospital discharge among 1,174 Medicaid enrollees ages 18 to 26, by whether they had an enrollment lapse
Table Footer Note

a df=1 and 1,173

Anchor for Jump
Table 3Regression estimates of service use by 1,174 Medicaid enrollees ages 18 to 26 in the 365 days after the index dischargea
Table Footer Note

a Analyses were also adjusted for all covariates: gender, age, race-ethnicity, psychiatric diagnoses, substance use disorder diagnosis, general medical illness diagnoses, prenatal care use, urban residence, prior inpatient mental health days, prior outpatient mental health clinic days, prior receipt of psychotropic medications, prior Medicaid enrollment days, and Medicaid enrollment category at discharge.

Table Footer Note

b ME (marginal effect) is equal to the difference in regression-adjusted predicted mean percentages for the two groups (no lapse and lapse), holding the values of all other covariates constant at the sampled values.

Table Footer Note

c Instrumental variable was age 18 or 20 (F=26.2, df=1 and 1,173, p<.001, for test of no effect on enrollment lapse).

Table Footer Note

d Includes 802 persons who had ≥2 outpatient clinic visits

Table Footer Note

e No instrumental variables

+

References

Davis M, Green M, Hoffman C: The service system obstacle course for transition-age youth and young adults; in Transition of Youth and Young Adults With Emotional or Behavioral Difficulties: An Evidence-Based Handbook. Edited by Clark HB, Unruh D. Baltimore, Brookes, 2009
 
Davis M, Koroloff N: The great divide: how public mental health policy fails young adults; in Research on Community-Based Mental Health Services for Children and Adolescents. Edited by Fisher WH. Bingley, United Kingdom, Emerald Group Publishing, 2006
 
Schwartz  K;  Damico  A:  Aging Out of Medicaid: What Is the Risk of Becoming Uninsured?   Washington, DC,  Kaiser Commission on Medicaid and the Uninsured, 2010
 
Fishman  E:  Aging out of coverage: young adults with special health needs.  Health Affairs 20(6):254–266, 2001
[CrossRef] | [PubMed]
 
Czajka  JL:  Medicaid Enrollment Gaps, 2005 to 2007 .  Washington, DC,  Mathematica Policy Research, 2012
 
Hill I: Is There a Hole in the Bucket? Understanding SCHIP Retention. Occasional paper 67, Washington, DC, Urban Institute, 2003
 
Pullmann  MD;  Heflinger  CA;  Satterwhite Mayberry  L:  Patterns of Medicaid disenrollment for youth with mental health problems.  Medical Care Research and Review 67:657–675, 2010
[CrossRef] | [PubMed]
 
Goldman  HH;  Frank  RG;  Burnam  MA  et al:  Behavioral health insurance parity for federal employees.  New England Journal of Medicine 354:1378–1386, 2006
[CrossRef] | [PubMed]
 
Zuvekas  SH:  Trends in mental health services use and spending, 1987-1996.  Health Affairs 20(2):214–224, 2001
[CrossRef] | [PubMed]
 
Sommers  BD:  Loss of health insurance among non-elderly adults in Medicaid.  Journal of General Internal Medicine 24:1–7, 2009
[CrossRef] | [PubMed]
 
Hogan  MF:  The public sector and mental health parity: time for inclusion.  Journal of Mental Health Policy and Economics 1:189–198, 1998
[CrossRef] | [PubMed]
 
Goldman  HH;  Grob  GN:  Defining “mental illness” in mental health policy.  Health Affairs 25:737–749, 2006
[CrossRef] | [PubMed]
 
Davis  M;  Geller  JL;  Hunt  B:  Within-state availability of transition-to-adulthood services for youths with serious mental health conditions.  Psychiatric Services 57:1594–1599, 2006
[CrossRef] | [PubMed]
 
Ringeisen  H;  Casanueva  CE;  Urato  M  et al:  Mental health service use during the transition to adulthood for adolescents reported to the child welfare system.  Psychiatric Services 60:1084–1091, 2009
[CrossRef] | [PubMed]
 
O’Brien  A;  Fahmy  R;  Singh  SP:  Disengagement from mental health services: a literature review.  Social Psychiatry and Psychiatric Epidemiology 44:558–568, 2009
[CrossRef] | [PubMed]
 
Hepburn  B:  Update on Maryland's Public Mental Health System.  Maryland Psychiatrist 29:12–14, 2003
 
Maryland's Public Mental Health System Provider Manual. Baltimore, Value Options Maryland. Available at maryland.valueoptions.com. Accessed July 12, 2012
 
Hansen  NB;  Lambert  MJ;  Forman  EM:  The psychotherapy dose-response effect and its implications for treatment delivery services.  Clinical Psychology: Science and Practice 9:329–343, 2002
[CrossRef]
 
Olfson  M;  Mojtabai  R;  Sampson  NA  et al:  Dropout from outpatient mental health care in the United States.  Psychiatric Services 60:898–907, 2009
[PubMed]
 
Aday  LA;  Andersen  R:  A framework for the study of access to medical care.  Health Services Research 9:208–220, 1974
[PubMed]
 
Medical Expenditure Panel Survey Household Component Data, 2003. Rockville, Md, Agency for Healthcare Research and Quality, 2006
 
Gelberg  L;  Andersen  RM;  Leake  BD:  The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people.  Health Services Research 34:1273–1302, 2000
[PubMed]
 
Bartels  SJ;  Clark  RE;  Peacock  WJ  et al:  Medicare and Medicaid costs for schizophrenia patients by age cohort compared with costs for depression, dementia, and medically ill patients.  American Journal of Geriatric Psychiatry 11:648–657, 2003
[CrossRef] | [PubMed]
 
Dickey  B;  Azeni  H:  Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care.  American Journal of Public Health 86:973–977, 1996
[CrossRef] | [PubMed]
 
Goldstein  JM;  Tsuang  MT:  Gender and schizophrenia.  Schizophrenia Bulletin 16:179–344, 1990
[CrossRef] | [PubMed]
 
Cooper  LA;  Gonzales  JJ;  Gallo  JJ  et al:  The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.  Medical Care 41:479–489, 2003
[PubMed]
 
Rural-urban commuting area codes. Seattle, WWAMI Rural Health Research Center. Available at depts.washington.edu/uwruca/index.php. Accessed Nov 1, 2011
 
Elixhauser A, McCarthy EM: Clinical Classifications for Health Policy Research, Version 2: Hospital Inpatient Statistics, 1995. Healthcare Cost and Utilization Project (HCUP 3) Research Note 1, AHCPR pub no 96-0017. Rockville, Md, Agency for Health Care Policy and Research, 1996
 
Graubard  BI;  Korn  EL:  Predictive margins with survey data.  Biometrics 55:652–659, 1999
[CrossRef] | [PubMed]
 
Christofides  LN;  Stengos  T;  Swidinsky  R:  On the calculation of marginal effects in the bivariate probit model.  Economics Letters 54:203–208, 1997
[CrossRef]
 
Angrist  J;  Imbens  G;  Rubin  D:  Identification of causal effects using instrumental variables.  Journal of the American Statistical Association 91:444–455, 1996
[CrossRef]
 
Hogan  JW;  Lancaster  T:  Instrumental variables and inverse probability weighting for causal inference from longitudinal observational studies.  Statistical Methods in Medical Research 13:17–48, 2004
[CrossRef] | [PubMed]
 
Angrist  JD;  Krueger  AB:  Instrumental variables and the search for identification: from supply and demand to natural experiments.  Journal of Economic Perspectives 15:69–85, 2001
[CrossRef]
 
Heckman  JJ:  Randomization as an instrumental variable.  Review of Economics and Statistics 78:336–341, 1996
[CrossRef]
 
Kreyenbuhl  J;  Nossel  IR;  Dixon  LB:  Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature.  Schizophrenia Bulletin 35:696–703, 2009
[CrossRef] | [PubMed]
 
Wang  PS;  Demler  O;  Kessler  RC:  Adequacy of treatment for serious mental illness in the United States.  American Journal of Public Health 92:92–98, 2002
[CrossRef] | [PubMed]
 
Wang  PS;  Berglund  P;  Olfson  M  et al:  Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:603–613, 2005
[CrossRef] | [PubMed]
 
Davis  M;  Vander Stoep  A:  The transition to adulthood for youth who have serious emotional disturbance: developmental transition and young adult outcomes.  Journal of Mental Health Administration 24:400–427, 1997
[PubMed]
 
Mitchell  AJ;  Selmes  T:  Why don’t patients attend their appointments? Maintaining engagement with psychiatric services.  Advances in Psychiatric Treatment 13:423–434, 2007
[CrossRef]
 
Cohen RA, Martinez ME: Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March, 2011. Atlanta, National Center for Health Statistics, 2011. Available at www.cdc.gov/nchs/nhis/releases.htm. Accessed May 17, 2012
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 33.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 32.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 61.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles