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

Abstract #67322

Robin Clark, PhD, Behavioral Health Policy Institute, Dartmouth Medical School, Strasenburgh 7250, Hanover, NH 03755-3862, 603-650-1246, Robin.E.Clark@Dartmouth.EDU and Haiyi Xie, PhD, New Hampshire-Dartmouth Psychiatric Research Center, Dartmouth Medical School, 2 Whipple Place, Lebanon, NH 03756.

Persons with co-occurring substance abuse and schizophrenia are among the most vulnerable and costly groups treated in the United States. Approximately two-thirds of all persons with schizophrenia depend on Medicaid or Medicare to pay for their treatment. Both public insurance programs serve people with disabilities, but Medicaid coverage in most states is more comprehensive than the federally administered Medicare program. Although studies have documented the prevalence and costs of co-occurring disorders among Medicaid beneficiaries relatively little is known about the prevalence, cost and patterns of service use for dual disorders among Medicare recipients or among the growing number of “dual eligibles” who qualify for both forms of public health insurance. We present findings on treated prevalence, cost to state and federal payers, and service use patterns for all Medicare or Medicaid beneficiaries in New Hampshire with a diagnosis of schizophrenia or schizoaffective disorder during 1999. We compare 2,199 beneficiaries with Medicare only, Medicaid only or with both types of insurance. Our results indicate significant differences in the prevalence of co-occurring disorders, the probability of hospital admission and use of emergency rooms for outpatient treatment. Further analyses suggest that some of these differences are related to variation in the underlying characteristics of beneficiaries in the three groups. Others appear to be related to differences in program design. One striking finding is the large proportion of beneficiaries with dual coverage. We discuss the implications of our findings for mental health consumers and for Medicare and Medicaid policy.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Identify differences in behavioral health coverage in the Medicare and Medicaid programs.
• Describe differences in the demographics, costs and service use patterns of persons with Medicare and Medicaid coverage.
• Describe differences in the costs and service use patterns of consumers with schizophrenia and with co-occurring substance use disorders within each insurance group.

Keywords: Mental Health Services, Substance Abuse Treatment

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.