Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.
Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia. Individuals with behavioral diagnoses had high rates of chronic medical comorbidities, and expenditures for medical (non-behavioral) diagnoses accounted for 74 % of their health care expenditures. Total Medicaid expenditure was approximately 15 billion dollars (equivalent to 18.91 billion in 2016 dollars) for individuals with any behavioral diagnosis. Medicaid fee-for-service beneficiaries with behavioral diagnoses have a high treated prevalence of individual medical comorbid conditions, and the majority of health care expenditures in these individuals are for medical, rather than behavioral health, services.
Department of Psychiatry and Behavioral Sciences, Emory University, 49 Jesse Hill Jr. Dr. SE, Suite 231, Atlanta, GA, 30303, USA. mcraig@emory.edu.|Division of General Medicine, Department of Medicine, Emory University, Atlanta, GA, 30303, USA. mcraig@emory.edu.
Martha C
MC
Ward
Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
Cathy
C
Lally
Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
Benjamin G
BG
Druss
D000328:Adult; D016208:Databases, Factual; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States; D055815:Young Adult
Healthcare costs; Medicaid; Medical comorbidity; Mental illness