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Medicaid Data Analysis

tion. Medicaid funds half of state and local support of mental illness treatments and one-third of specialty substance abuse treatment.

The authors set out to understand where integrated psychiatric and substance abuse services may need to be provided for Medicaid beneficiaries. They examined the location of services used by persons with mental and substance use disorders from 1999 Medicaid data obtained from the Centers for Medicare and Medicaid Services for five states: Arkansas, Colorado, Indiana, New Jersey, and Washington.

Robin E. Clark, Ph.D., and Mihail Samnaliev, Ph.D., at the Center for Health Policy and Research, University of Massachusetts Medical School, and Mark P. McGovern, Ph.D., Psychiatric Research Center, Dartmouth Medical School, analyzed whether beneficiaries with co-occurring disorders were treated in community-based settings, inpatient facilities, emergency departments, or hospital outpatient departments.

The full dataset of close to 126,513 beneficiaries ages 21 through 64 included 17,952 Medicaid beneficiaries with co-occurring disorders. Three-fourths of patients with co-occurring disorders were younger than age 45. Racial and ethnic minorities made up a substantial proportion of the population, ranging from 20.8% in Indiana to 61.2% in New Jersey.

Heavy inpatient and emergency department use were common among Medicaid beneficiaries with co-occurring disorders. One in five beneficiaries treated in these settings received no Medicaid funded behavioral health treatment elsewhere. Beneficiaries with co-occurring disorders were three to six times more likely to be hospitalized for psychiatric treatment during 1999 than were those with a mental health diagnosis alone.

Arkansas was the one state in which co-occurring disorders did not reduce the odds that patients would receive community-based mental health treatment. The authors suggest that reimbursement policies favoring com
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