Over the past week, we have looked at some of the ground-level specifics of the implementation of the Patient Protection and Affordable Care Act (PPACA). We looked at the types of health insurance exchanges (see The Insurance Marketplaces Are Here all members) and who would “fall” into the so-called Medicaid “donut hole” (see The Looming Health Care Reform ‘Donut Hole’ all members) in states that are not expanding Medicaid. And, we did a deeper dive into the “donut hole”, estimating the number of Americans with behavioral disorders that will likely not have coverage in the year ahead (see How Many Consumers With An SMI Or Addiction Fall In The New Medicaid ‘Donut Hole’? all members).
Today, I want to look at the expansion of coverage in the field – the number of Americans with a behavioral health disorder who will have access to insurance coverage through the Medicaid expansion. How many? An estimated 6.3 million individuals will be newly eligible for Medicaid in these states in 2014 – ranging from more than 2.4 million in California to as few as 12.5 thousand in Vermont. Of these, our estimate is that approximately 1.2 million individuals have a serious mental illness and/or an addictive disorder.
The Substance Abuse and Mental Health Services Administration (SAMHSA) constructed estimates by state of the prevalence of serious mental illness (SMI), serious psychological distress, and substance use disorder (SUD) for populations newly insured under PPACA and compared them to each state’s current Medicaid population and the national average. SAMHSA’s numbers paint a picture of high (and likely unmet) demand for behavioral health treatment services in the Medicaid expansion population.
The table below shows the SAMHSA estimates for SMI & SUD disorders prevalence in populations covered under Medicaid expansion in states likely to expand Medicaid in 2014 (uninsured adults with incomes below 138% of FPL) – and translates them into an estimated number of newly covered individuals.
|SAMHSA Estimates For The Prevalence Of SMI & SUD Disorders In Population Covered Under Medicaid Expansion In States Likely To Expand Medicaid in 2014 (numbers in 1,000’s)|
|State||Medicaid Expansion Population||Estimate Of Share Of Medicaid Expansion Population With SMI||Estimate Of Share Of Medicaid Expansion Population With SUD|
|CA||2,463.4||4.4% (108.4)||10.3% (253.7)|
|CO||278.9||5.0% (13.9)||12.1% (33.7)|
|CT||94.3||10.2% (9.6)||23.2% (21.9)|
|DE||28.0||15.0% (4.2)||19.6% (5.5)|
|DC||14.2||5.3% (0.7)||24.3% (3.4)|
|HI||30.7||4.4% (1.4)||14.4% (4.4)|
|IL||681.5||4.9% (33.4)||14.9% (101.5)|
|KY||323.0||10.0% (32.3)||14.2% (45.9)|
|MD||195.5||3.7% (7.2)||13.1% (25.6)|
|MA||91.3||7.0%* (6.4)||30.8% (28.1)|
|MN||142.5||18.9% (26.9)||15.1% (21.5)|
|NV||200.6||4.2% (8.4)||16.1% (32.3)|
|NH||43.1||7.7% (3.3)||18.0% (7.8)|
|NJ||333.3||5.9% (19.7)||9.0% (30.0)|
|NM||170.4||4.3% (7.3)||8.4% (14.3)|
|ND||25.6||4.7% (1.2)||18.4% (4.7)|
|OR||265.7||10.2% (27.1)||12.2% (32.4)|
|RI||44.4||11.2% (5.0)||26.2% (11.6)|
|VT||12.5||15.9% (2.0)||17.4% (2.2)|
|WA||350.2||5.1% (17.9)||20.5% (71.8)|
|WV||125.3||10.8% (13.5)||17.9% (22.4)|
|* Prevalence of SMI in the current Medicaid population. Sample size was insufficient to estimate for the Medicaid expansion population.|
What are the public policy implications of Medicaid expansion in a community in one of these states? The closest available parallel to the upcoming 2014 Medicaid expansion occurred in Oregon in 2008 when the state extended Medicaid to a limited number of low-income adults. The National Bureau of Economic Research (NBER) all members studied this population one year after coverage and found that moving low-income adults from uninsured to insured resulted in a 25% overall increase in health care service consumption, and was accompanied by improvements in self-reported physical and mental health. Specifically, NBER found a 25% decline in unpaid medical bills sent to a collection agency for this Medicaid cohort. There was also an increased likelihood for outpatient, inpatient, and prescription drug use: 35% for outpatient care; 30% for hospital admissions; and 15% for prescription drugs.
For another free resource, see: Health Care Reform Update: State Medicaid Expansion Calculus all members