The Impact of Medicaid Managed Care on Health Service Utilization Among Adults With Intellectual and Developmental Disabilities

Yamaki, Kiyoshi; Wing, Coady; Mitchell, Dale; Owen, Randall; Heller, Tamar

doi:10.1352/1934-9556-57.4.289

Cited by 18 publications

(14 citation statements)

References 42 publications

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“…Consistent with the present findings, Beatty et al (2003) reported that the access to PCPs by enrollees with physical disabilities didn't differ between FFS and MMC. Other researchers reported that MMC was associated with reduced access to community services including both primary care and specialist services in enrollees with disabilities in general (Burns, 2009b) and specifically with enrollees with intellectual and developmental disabilities (IDD) (Yamaki et al, 2019). Some researchers observed increased utilization of community-based services only among MMC enrollees with disabilities in urban areas where the services were readily available (Coughlin, Long, & Graves, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Because of budget constraints, many states have been transitioning enrollees with disabilities to MMC with a hope of both reducing or stabilizing the state's costs and ensuring better access to health services for enrollees (Sparer, 2012). Yet, previous researchers have reported mixed findings on the impact of MMC (Burns, 2009b;Caswell & Long, 2015;Coughlin et al, 2008;Shern et al, 2007;Yamaki et al, 2019). For persons with early-acquired physical disabilities, Medicaid is a primary source of health services required to meet their complex health care needs, some of which may intensify as they age.…”

Section: Discussionmentioning

confidence: 99%

“…It could be attributable, at least partially, to a decrease of ED visits due to conditions that were not emergencies and/or treatable in the community-based health services. A notable proportion of ED visits by adults with physical disabilities and IDD has been associated with such conditions (Mann, Royer, McDermott, et al, 2015; Mann, Royer, Turk, et al, 2015; Yamaki et al, 2019). Previous findings have suggested that MMC was effective in reducing their ED visits with these conditions (Verdier et al, 2009; Yamaki et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…A notable proportion of ED visits by adults with physical disabilities and IDD has been associated with such conditions (Mann, Royer, McDermott, et al, 2015; Mann, Royer, Turk, et al, 2015; Yamaki et al, 2019). Previous findings have suggested that MMC was effective in reducing their ED visits with these conditions (Verdier et al, 2009; Yamaki et al, 2019). Future studies should explore potential causes of the ED reduction to understand the MMC impact on the target population better.…”

Section: Discussionmentioning

confidence: 99%

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Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

et al. 2018

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Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC ( n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service ( n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month ( p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month ( p < .001), and state expenditures by US$839/month ( p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees’ age.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

et al. 2018

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“…We had only one period of data available before the transition to MMC; we cannot include that the trends were parallel, but the use of IPSW to match on observables make this assumption plausible. IPSW and DID together have been used widely in similar research on health policy (Dimick & Ryan, 2014; Wing et al, 2018; Yamaki et al, in press). We calculated the standardized differences between the weighted and unweighted FFS groups and the MMC group to determine how effective the IPSW was.…”

Section: Methodsmentioning

confidence: 99%

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

Owen

Crabb

Stober

et al. 2019

Journal of Disability Policy Studies

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The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.

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Medicaid Enrollment and Service Use Among Adults With Down Syndrome

et al. 2023

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ImportanceDown syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid.ObjectiveTo describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid.Design, Setting, and ParticipantsIn this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023.Main Outcomes and MeasuresData were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use.ResultsThis cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome.Conclusion and RelevanceThis cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.

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The Impact of Medicaid Managed Care on Health Service Utilization Among Adults With Intellectual and Developmental Disabilities

Cited by 18 publications

References 42 publications

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

Medicaid Enrollment and Service Use Among Adults With Down Syndrome

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