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Medicaid discontinuity leads to higher costs, hospital use in depression

Adults with major depression who experienced Medicaid discontinuity had significantly greater use of ED and inpatient services than those with continuous coverage.

“For patients with mental illness, Medicaid discontinuity may be a particular concern given the well-known barriers to [mental health] treatment,” Xu Ji, MSPH, of Emory University, and colleagues wrote. “When such patients lose Medicaid, they may face elevated out-of-pocket payment for [mental health] services. Consequently, depressed patients — especially low-income patients eligible or nearly eligible for Medicaid, for whom even a ‘minor’ health expense can create significant financial strain — may skip visits with [mental health] specialists and experience disruptions in outpatient treatment... Thus, gaps in these treatments caused by coverage disruptions can precipitate exacerbation of beneficiaries’ depression symptoms and increase the likelihood of acute episodes, leading to expensive and otherwise avoidable emergent department and inpatient care.”

To assess associations between Medicaid discontinuities and service utilization among adults with major depression, researchers analyzed 2003 to 2004 Medicaid Analytic eXtract Files for 139,164 adults with major depression.

Coverage disruptions occurred among 29.4% of participants.

Instrumental variables models indicated participants with coverage disruptions incurred $650 more in acute care costs per person per Medicaid-covered month, compared with those with continuous coverage (P < .001). This was indicated by an increase of 0.1 ED visits per-person-month and 0.6 more inpatient days per-person-month (P < .001 for both).

Increases in acute costs contributed to an overall increase in all-cause costs of $310 per-person-month (P < .001).

“Our results suggest that for adults with severe depression, those experiencing disruptions in Medicaid coverage have, on average, significantly greater use of costly ED and inpatient services, compared to those with continuous coverage. Likewise, the longer length of coverage disruptions a patient experienced, the more intensive the patient’s use of acute services when reenrolled,” the researchers wrote. “Further, the increase in utilization of ED/inpatient services was associated with a significant increase in monthly acute care costs.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.