title: Changes in health care use and costs after a break in Medicaid coverage among persons with depression.
abstract: OBJECTIVE
  The objective of this study was to assess changes in individual beneficiaries' utilization and expenditures that occur when individuals with depression, who often require maintenance treatment, return to Medicaid after a period of interrupted Medicaid coverage.
  
  
  METHODS
  Data from 1999 to 2002 Florida Medicaid claims from and eligibility files for beneficiaries with depression whose coverage was interrupted (N=1,946) were used to assess individual changes in the number of inpatient episodes, length of inpatient stay, emergency department visits, and total Medicaid expenditures between the three-month period immediately before and the three-month period immediately after an interruption in coverage. Multivariate analyses were used to assess how beneficiary characteristics are associated with changes in utilization and expenditures.
  
  
  RESULTS
  The number of inpatient episodes increased by .054 episode (p<.001), the length of inpatient stay increased by .32 day (p<.001), the number of emergency department visits increased by .57 visit (p<.001), and total Medicaid expenditures increased by 430 dollars (p<.001) in the three-month period after an interruption in coverage of more than one month. Individuals with depression who qualified for Medicaid because of a disability had a greater likelihood of experiencing higher expenditures after an interruption than individuals who were not disabled.
  
  
  CONCLUSIONS
  Utilization of emergency and inpatient services and Medicaid expenditures significantly increased for beneficiaries with depression when they returned to Medicaid after experiencing a temporary loss in coverage, especially for beneficiaries with a documented disability. These findings point to the need for further research to assess the impact of interruptions in Medicaid.
authors.affiliation: Health Services Research, Management and Policy, University of Florida, Gainesville 32611-0195, USA. jharman@phhp.ufl.edu
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.forename: Allyson G
authors.initials: AG
authors.lastname: Hall
authors.forename: Jianyi
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D003710:Demography; D003865:Major Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D009936:Organizational Innovation; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents