Recorded presentation

Neil Thakur, PhD, Health Services Research and Development/ 124C, Department of Veterans Affairs, 810 Vermont Ave. NW, Washington, DC 20420, 202-254-0232, neil.m.thakur@aya.yale.edu, John S. Preisser, PhD, Department of Biostatistics, University of North Carolina - Chapel Hill, 3105 F McGavran-Greenberg Hall, Chapel Hill, NC 27599, and Chunyuan Liu, MS, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 101 Conner Drive, Suite 302, Chapel Hill, NC 27514.

Medicaid capitation has been shown to reduce utilization of mental health services. A previous study in King County, Washington, suggests Medicaid capitation is associated with cost shifting from county funded mental health care to local jails. However, to date, few evaluations have specifically explored these associations for adults with a serious mental illness (SMI), who are among those most dependent upon public sector services. In this study, we compare cohorts of persons with serious mental illness (n= 14,987) versus those without these diagnoses (n=29,363) drawn from a sample of King County social service users. We note the changes in probability of use for county mental health care, jail detention, and jail-based psychiatric services over 22 quarters, controlling for demographic characteristics, time varying Medicaid eligibility and county-wide utilization trends. Preliminary analyses suggest that, in the year following the introduction of Medicaid capitation, county residents with SMI relative to those without SMI, experienced a decreased probability of county mental health and jail psychiatric service use and an increased probability of jail detention. These preliminary findings will be confirmed in subsequent analyses presented at the APHA conference, and contextualized within King County policy events. Hypotheses will be presented about the administrative and clinical mechanisms underlying these trends along with their implications for further research.

Learning Objectives:

• At the end of the session, participants will understand how capitated Medicaid is associated with utilization of jails, county mental health services, and jail based mental health services for persons with serious mental illness in King County, and discuss how clinical and policy factors which may affect these associations in King County and other parts of the country.

Keywords: Managed Care, Criminal Justice

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.

Recorded presentation