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Articles   |    
Identifying Young Adults at Risk of Medicaid Enrollment Lapses After Inpatient Mental Health Treatment
Maryann Davis, Ph.D.; Michael T. Abrams, M.P.H.; Lawrence S. Wissow, M.D., M.P.H.; Eric P. Slade, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300199
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Dr. Davis is with the Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester (e-mail: maryann.davis@umassmed.edu). Mr. Abrams is with The Hilltop Institute, University of Maryland, Baltimore County. Dr. Wissow is with the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Slade is with the Mental Illness Research, Education and Clinical Center, Capitol Healthcare Network (VISN5), U.S. Department of Veterans Affairs, and with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study sought to describe Medicaid disenrollment rates and risk factors among young adults after discharge from inpatient psychiatric treatment.

Methods  The sample included 1,176 Medicaid-enrolled young adults ages 18 to 26 discharged from inpatient psychiatric care in a mid-Atlantic state. Medicaid disenrollment in the 365 days postdischarge and disenrollment predictors from the 180-day predischarge period (antecedent period) were identified from administrative records. Classification and regression tree and probit regression analysis were used.

Results  Thirty-two percent were disenrolled from Medicaid within a year of discharge. Both analytical approaches converged on four main risk factors: being in the Medicaid enrollment category for persons with a nondisabled low-income parent or for a child in a low-income household, being age 18 or 20 at discharge, having a Medicaid enrollment gap in the antecedent period, and having no primary care utilization in the antecedent period. For the 48% of the sample continuously enrolled in the antecedent period who were in the enrollment categories for disabled adults or foster care children, the disenrollment rate was 13%.

Conclusions  A substantial minority of Medicaid-enrolled young adults discharged from inpatient care were disenrolled from Medicaid within a year. About half the sample had a low disenrollment risk, but the other half was at substantial risk. Risk factors largely reflected legal status changes that occur among these transition-age youths. Identifying inpatients at high risk of disenrollment and ensuring continuous coverage should improve access to needed postdischarge supports. Regular primary care visits may also help reduce unintended Medicaid disenrollment in this population.

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Figure 1 Classification and regression tree analysis of Medicaid disenrollment rates among subgroups of young adults in the 365 days after discharge from a psychiatric hospitalizationa

a F&C/SCHIP, in Medicaid category for families and children or in the State Children’s Health Insurance Program (SCHIP)

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Table 1Independent variables used in an analysis of Medicaid lapses among 1,176 young adultsa
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a Variables were generated by algorithmic review of Medicaid claims, enrollment records, and demographic files for periods noted.

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b A binary variable coded as 1, presence of the event, or 0, absence

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c 180 days before the discharge from the index hospitalization

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d When the five most frequent diagnoses fell into more than one category, the individual was assigned to the category associated with the greatest morbidity, in the following order: schizophrenia, bipolar disorder, depressive disorder, and other mental illness.

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e Definitions used in previous studies (26,27)

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f Adapted from Healthcare Effectiveness Data and Information Set (HEDIS) definitions of ambulatory care visits (26)

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Table 2Characteristics of 1,176 Medicaid-enrolled young adults discharged from inpatient psychiatric care, by continuity of enrollment in the 365 days postdischarge
Table Footer Note

a Log-likelihood=–595, χ2= 293, pseudo-R2=.20, N=1,176, df=23

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b Incremental change in disenrollment risk for each incremental change in the listed variable

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c Upper bound given to protect individual patient confidentiality

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d Mutually exclusive categories (yes-no binary indicator)

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e Includes index hospitalization

Table Footer Note

*p<.05, **p<.01, ***p<.001

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