The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #54468

Bentson H. McFarland, MD PhD¹, Lynn E McCamant, MA¹, and Nancy M Barron, PhD². (1) Department of Psychiatry, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, 503 245-6550, mcfarlab@ohsu.edu, (2) Community and Family Services, Multnomah County, 421 S.W. Sixth Avenue, Suite 600, Portland, OR 97204

Medicaid is an important and growing payer for substance abuse treatment. Many states have converted their Medicaid programs from fee for service to managed care. Questions have arisen about the impact of managed care on Medicaid clients with chemical dependency. This project examined outcomes of public substance abuse treatment for Medicaid and non-Medicaid clients before and after Oregon's 1995 conversion of Medicaid chemical dependency services from fee for service to capitation. Subjects were interviewed at baseline as well as at six months and twelve months thereafter using the Addiction Severity Index (ASI). Multi-variate logistic models that accounted for repeated measures (estimated with the MLwiN software program) were used to analyze the dichotomized ASI alcohol and drug composite scores. Attention was directed to interaction terms in the models corresponding to "differences of differences" between Medicaid versus non-Medicaid clients in the pre- versus post-managed care eras. Subjects were 553 adults (59% male, average age 35, 64% white, 56% with alcohol problems, 78% with drug problems, 37% arrested in year before baseline interview, 25% arrested in year after baseline interview, 43% Medicaid clients) of whom 60% were examined in the fee for service (pre-managed care) era. After adjustment for covariates, interaction terms in both the alcohol and the drug models were non-significant. These results suggest that conversion from fee for service to capitation had little impact on chemical dependency treatment outcomes for Medicaid clients in Oregon.

Learning Objectives:

At the conclusion of this session, participants will be able to
• Discuss the importance of Medicaid as a payer for substance abuse treatment,
• Summarize developments in Medicaid managed care, and
• Describe the impact of Medicaid managed care on treatment outcomes for clients with substance abuse problems.

Keywords: Drug Abuse, Alcohol Problems

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.