Changes in expenditures for Medicaid enrollees with a behavioral health diagnosis: 2005-2010

Abstract

Objective: The Affordable Care Act requires care coordination for individuals with behavioral health problems due to frequent physical health problems.  The potential for cost savings is often used to motivate the use of care coordination.  This paper examined Medicaid physical and behavioral health expenditures over a six year period for individuals with a behavioral health diagnosis to explore whether current and future costs are sufficient to justify care coordination.

Objective: The Affordable Care Act requires care coordination for individuals with behavioral health problems due to frequent physical health problems. The potential for cost savings is often used to motivate the use of care coordination.  This paper examined Medicaid physical and behavioral health expenditures over a six year period for individuals with a behavioral health diagnosis to explore whether current and future costs are sufficient to justify care coordination.

Methods: The analysis used Florida Medicaid enrollment and claims data. Transitions between expenditure quintiles were examined for people with a behavioral health diagnosis, as was the likelihood of exiting the Medicaid program. We also examined the distribution of expenditures related to physical and mental health problems and how this changed over time.

Results: Individuals with a behavioral health diagnosis were in higher expenditure groups in 2005, were more likely to move to higher expenditure groups, and were less likely to exit the Medicaid program between 2005 and 2010 than people without a behavioral health diagnosis. Individuals with behavioral health problems had higher expenditures for physical health care than behavioral health care.

Conclusions: Medicaid expenditures are high for people with a behavioral health diagnosis and have a higher likelihood of increasing over time. Given high current and future costs, modest reductions in costs may be sufficient to justify the use of care coordination programs for people with physical and behavioral health diagnoses.