Harrow BS, Larson MJ, Kasten LE; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1999; 16: 156.

New England Research Institutes, Watertown, MA 02454, USA.

RESEARCH OBJECTIVE: Managed care places limits on both the amount and types of services that clients may receive. In the substance abuse treatment system, which has multiple payers, the introduction of managed care provides the opportunity for costs to be shifted from one public program to another. This paper examines the use of substance abuse services by publicly funded Medicaid managed care clients in Massachusetts to determine if there is cost-shifting from the Medicaid managed care clients to an unmanaged Medicaid group. STUDY DESIGN: Data for this paper comes from a larger study of the impact of managed care on adult substance abusing public sector patients in Massachusetts. This paper uses several data sources: (a)in-person interview data about service use in the past 6 months; (b)Medicaid enrollment files; and (c)the MA Bureau of Substance Abuse Services (BSAS) treatment admission and billing files of admissions at publicly funded facilities from all payers. Respondents were interviewed after admission to detoxification services, with an age range of 18 to 64. Preliminary analysis of the first 249 subjects with admission and billing records is completed. Clients were classified into three groups according to their Medicaid enrollment status at the time of their index admission to detoxification: 1) Medicaid managed if they were enrolled in the Medicaid behavioral health carve-out managed care program (MCO); 2) Medicaid unmanaged or fee-for service; and 3) Uninsured; those unenrolled in Medicaid, whose services would be paid for by the State public program (BSAS). BSAS data were used to look at the source of funding and payment amount for six months prior to the index admission, the index admission, and 2 months after the index admission. For purposes of this paper we have defined "cost-shifting" as occurring when BSAS pays for Medicaid covered services for Medicaid clients and "cost-sharing" as occurring when BSAS funds services not covered by Medicaid for Medicaid clients. PRINCIPAL FINDINGS: For the six month period prior to the index admission, $500, $560 and $640 per client were spent on substance abuse services for the Uninsured, MCO and Medicaid unmanaged groups respectively. Overall, the Uninsured group had the most costly index admission, $1200 as compared to $930 and $990 for the MCO and Medicaid unmanaged groups, respectively. This group also cost the most during the 2 month post period, primarily due to a higher utilization of BSAS funded recovery home services. The readmittance rate to detoxification was lower for this group, 24% as compared to about 30% for both the Medicaid groups. For the MCO clients there was little evidence of cost shifting. During the 6-month period prior to the index admission, less than 10 percent of the $560 per client spent on substance abuse services were paid for by BSAS. Also for this group, in the 2-month period following the index admission, nearly all of the costs due to readmission to detoxification services were paid for by the MCO. There was however cost-sharing during this period. Nearly 60 percent of the $800 per client spent on substance abuse services during the 2 months after detoxification was funded by BSAS for services received in recovery home and therapeutic community modalities, which are not covered by Medicaid. We found both cost-shifting and cost-sharing with the Medicaid unmanaged group. Regarding cost-shifting, this Medicaid unmanaged group received BSAS funded detoxification services, at a cost of $300 per client during the 6 month period prior to the index admission and $150 per client for the 2 month post period. There was also evidence of cost-sharing for the Medicaid unmanaged group. During the 2 months after the index admission BSAS funded $220 worth of services in recovery home and therapeutic community modalities. CONCLUSIONS: There was no evidence of cost-shifting for the Medicaid managed clients in our study. However, these clients did receive BSAS funded services that are not covered by Medicaid, supporting evidence of cost-sharing. We did find cost-shifting for the Medicaid unmanaged clients. Uninsured clients appeared to get more care. In particular, their use of recovery homes in the 2-month period after the index detoxification admission was greater than that for the two Medicaid groups. This greater use of recovery homes may lead to improved outcomes. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: This preliminary analysis used billing data to measure the cost and source of payment of services for publicly funded substance abusing adults. We found that it is important to draw a distinction between cost-shifting and cost-sharing. For the Medicaid unmanaged group, there were Medicaid reimbursement services being funded by BSAS. This may indicate that there were missed opportunities for federal matching funds had these services been billed to Medicaid.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Case-Control Studies
• Cost Allocation
• Cost Sharing
• Fee-for-Service Plans
• Humans
• Managed Care Programs
• Massachusetts
• Medicaid
• Substance-Related Disorders
• Therapeutic Community
• economics
• hsrmtgs

Other ID:

• HTX/20602918

UI: 102194607

From Meeting Abstracts