Behavioral And Other Chronic Conditions Among Adult Medicaid Enrollees: Implications For Work Requirements

Are disparities in mental health care for Medicaid beneficiaries lower in managed care?

BACKGROUND

There are large and persistent racial and ethnic disparities in the use of mental health care in the United States. Medicaid managed care plans have the potential to reduce racial and ethnic disparities in use of mental health care through monitoring of need and active management of use of services across the populations they cover. This study compares racial and ethnic disparities among Medicaid beneficiaries in managed care with those not in managed care.

METHODS

We compared Medicaid beneficiaries enrolled health maintenance organizations (HMOs) with those in fee-for-service (FFS) using data from the 2007-2015 Medical Expenditure Panel Survey (N = 26,113). We specified two-part propensity score adjusted models to estimate differences in mental health related emergency department visits, hospital stays, prescription fills, and outpatient visits overall and by race/ethnicity.

RESULTS

HMO enrollment was associated with lower odds of having a mental health prescription (OR = 0.86, 95 % CI 0.78-0.96) or outpatient visit (OR = 0.82 95 % CI 0.73-0.92). These differences were similar across racial and ethnic groups or larger among Non-Hispanic Black and Hispanic beneficiaries than among Non-Hispanic White beneficiaries.

CONCLUSIONS

Medicaid managed care has not improved the inequitable allocation of mental health care across racial and ethnic groups. Explicit attention to monitoring of racial and ethnic differences in use of mental health care in Medicaid managed care is warranted.

IMPLICATIONS

Improvement in racial and ethnic disparities in mental health care in Medicaid manage care is unlikely to occur without targeted accountability mechanisms, such as required reporting or other contracting requirements.

Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements

CONTEXT

Twenty states are pursuing community engagement requirements ("work requirements") in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries.

METHODS

The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551).

FINDINGS

Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population-particularly women, older adults, and those with less education-would not currently satisfy a 20-hour-per-week requirement.

CONCLUSIONS

Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

Medicaid's Post-ACA Paradoxes

Medicaid's experience one decade after the passage of the Affordable Care Act represents extreme divergence across the American states in health care access and utilization, policy designs that either expand or restrict eligibility, and delivery model reforms. The past decade has also witnessed a growing ideological divide about the very purpose and intent of the Medicaid program and its place within the US health care system. While liberal-leaning states have actively embraced the program and used it to expand health coverage to working adults and families as an effort to improve health and prevent poverty and the insecurity and instability that comes with high medical costs (evictions, bankruptcy), conservative states have actively rejected this expanded idea of Medicaid and argued instead that the program should revert back to its "original" purpose and be used only for the "truly" needy. This article highlights several paradoxes within Medicaid that have led to this growing bifurcation, and it concludes by shedding light on important targets for future reform.

Assessment of Health Status and Barriers to Employment Among Medicaid Beneficiaries Not Meeting Work Requirements After Accounting for State Medical Frailty Exemptions

This cross-sectional study quantifies the proportion of nonexempt Medicaid beneficiaries not meeting work requirements, compares their health with nonexempt beneficiaries fulfilling requirements, and assesses their inability to work for health-related reasons.