Changes in health care use and costs after a break in Medicaid coverage among persons with depression.

OBJECTIVE: The objective of this study was to assess changes in individual beneficiaries' utilization and expenditures that occur when individuals with depression, who often require maintenance treatment, return to Medicaid after a period of interrupted Medicaid coverage.
METHODS: Data from 1999 to 2002 Florida Medicaid claims from and eligibility files for beneficiaries with depression whose coverage was interrupted (N=1,946) were used to assess individual changes in the number of inpatient episodes, length of inpatient stay, emergency department visits, and total Medicaid expenditures between the three-month period immediately before and the three-month period immediately after an interruption in coverage. Multivariate analyses were used to assess how beneficiary characteristics are associated with changes in utilization and expenditures.
RESULTS: The number of inpatient episodes increased by .054 episode (p<.001), the length of inpatient stay increased by .32 day (p<.001), the number of emergency department visits increased by .57 visit (p<.001), and total Medicaid expenditures increased by 430 dollars (p<.001) in the three-month period after an interruption in coverage of more than one month. Individuals with depression who qualified for Medicaid because of a disability had a greater likelihood of experiencing higher expenditures after an interruption than individuals who were not disabled.
CONCLUSIONS: Utilization of emergency and inpatient services and Medicaid expenditures significantly increased for beneficiaries with depression when they returned to Medicaid after experiencing a temporary loss in coverage, especially for beneficiaries with a documented disability. These findings point to the need for further research to assess the impact of interruptions in Medicaid.