Association for Public Policy Analysis & Management

Panel: State Policies and Behavioral Health

(Health Policy)

As of January 2018, 33 states have expanded Medicaid to individuals earning up to 138 percent of the federal poverty level. This expansion has added approximately 15 million additional people to Medicaid rolls across the country. With the expansion, a number of other Medicaid provisions have encouraged greater provider provision of services to the newly beneficiaries. Evidence suggests that the prevalence of mental health and substance use conditions is particularly high among the Medicaid population, individuals with behavioral health issues enroll in Medicaid at disproportionately higher rates.  In 2011, nearly half of Medicaid expenditures ($131 billion) were on beneficiaries with a behavioral health diagnosis. Therefore, it is particularly important that behavioral health be specifically considered when evaluating the impacts of the insurance reforms. Additionally, there are still on-going policy efforts to roll back health insurance reforms (e.g. Medicaid expansion). The impacts of these contraction may not be symmetrical to the effects of expansion, and therefore are also of interest from a policy perspective.

This session presents 3 papers that examine behavioral health in the context of changes in Medicaid.  Using detailed micro-data from the National Survey on Drug Use and Health, administrative data from TennCare (Tennessee’s Medicaid program), and government data on the behavioral healthcare workforce, these papers offer insights on the impacts of Medicaid coverage and physician reimbursements policy.  These papers employ rigorous econometric designs such as event-studies and differences-in-differences to identify the causal effects of these policies.

The first paper studies the effects of expanding provider participation in Medicaid by substantially increasing reimbursement rates in all states.  Using rich micro level data from the National Survey on Drug Use and Health, this study expands our understanding of the role primary care providers play in delivering behavioral health services.  The nation’s current shortage of behavioral health professionals makes this an important policy question.  The second paper examines the consequences for behavioral health outcomes of a large scale Medicaid disenrollment in Tennessee in 2005 using on administrative hospitalization data.  The effects of such a disenrollment is a particularly salient policy question with the looming potential of a roll back in Medicaid’s most recent expansion.  In particular, the population that lost TennCare coverage bears striking similarities to populations that gained Medicaid eligibility under the ACA. The final paper addresses whether the increase in demand following the Medicaid expansion has induced providers to expand their services.  Exploiting that lower income populations suffer higher rates of opioid use disorder (OUD), the authors use government data to examine if the number buprenorphine waivered physicians increases in the wake of newly eligible Medicaid recipients. This paper contributes to two important policy issues: insurance reform and the opioid crisis, showing both the wide ranging effects of insurance reform and offering another potential policy response to opioid use and treatment.

The session offers substantial diversity in terms of gender, race, ethnicity, seniority, and institution.  This session provides important evidence for action on current policy questions of interest to a broad audience, thus aligning with APPAM’s overall theme.