BACKGROUND: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. OBJECTIVE: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. RESEARCH DESIGN: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. MEASURES: Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. RESULTS: We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. CONCLUSIONS: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
BACKGROUND: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. OBJECTIVE: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. RESEARCH DESIGN: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. MEASURES: Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. RESULTS: We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. CONCLUSIONS: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
Authors: Thomas Lehnert; Dirk Heider; Hanna Leicht; Sven Heinrich; Sandro Corrieri; Melanie Luppa; Steffi Riedel-Heller; Hans-Helmut König Journal: Med Care Res Rev Date: 2011-08 Impact factor: 3.929
Authors: Vivian L Towe; Laura Leviton; Anita Chandra; Jennifer C Sloan; Margaret Tait; Tracy Orleans Journal: Health Aff (Millwood) Date: 2016-11-01 Impact factor: 6.301
Authors: Katherine Diaz Vickery; Peter Bodurtha; Tyler N A Winkelman; Courtney Hougham; Ross Owen; Mark S Legler; Erik Erickson; Matthew M Davis Journal: Health Aff (Millwood) Date: 2018-01 Impact factor: 6.301
Authors: Jan Gryczynski; Robert P Schwartz; Kevin E O'Grady; Lauren Restivo; Shannon G Mitchell; Jerome H Jaffe Journal: Health Aff (Millwood) Date: 2016-01 Impact factor: 6.301
Authors: Jeonghoon Ahn; Jeffrey S McCombs; Changun Jung; Tim J Croudace; David McDonnell; Haya Ascher-Svanum; Eric T Edgell; Lizheng Shi Journal: Value Health Date: 2008 Jan-Feb Impact factor: 5.725