Panel Paper: The Effect of Medicaid Health Homes on Individuals with Behavioral Health Disorders

Saturday, November 9, 2019
I.M Pei Tower: Majestic Level, Vail (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Chandler McClellan1, Catherine Maclean2, Brendan Saloner3, Beth McGinty3 and Michael F. Pesko4, (1)Substance Abuse and Mental Health Services Administration, (2)Temple University, (3)Johns Hopkins University, (4)Georgia State University

Background: Health Homes are an optional state program created under the Affordable Care Act to deliver comprehensive and coordinated services for chronically-ill enrollees. Improving access and quality of care is a key objective of Health Homes. States pursuing Health Homes receive enhanced federal payment for services and must create a state plan amendment specifying targeted populations and services. In total, 16 states (including DC) implemented statewide Health Homes for populations with severe mental illness (SMI), 4 for populations with substance use disorders (SUDs), and 3 for both conditions between 2011-2016. Methods: We conducted a secondary data analysis of repeated cross-sections of the restricted National Survey on Drug Use and Health (NSDUH) 2010-2016. We focused on a nationally representative population of non-institutionalized Medicaid enrollees (N=41,700). We estimated differences-in-differences regression models with state and year fixed effects, indicators for state-years where the Health Homes was in effect, individual demographics, and other time-varying state characteristics (e.g., Medicaid expansion). Data were survey-weighted and standard errors were clustered around state. Outcomes included self-reported behavioral health and general medical care utilization, and health status. We modeled the presence of any statewide behavioral Health Home, and then separately presence of Health Homes programs targeting SMI versus SUD. We confirmed that models satisfied the parallel trends assumption. Results: Overall, the presence of any behavioral Health Home was associated with increased utilization of SUD treatment of 1.3 percentage points (P<.01), a 23% increase over the baseline mean, but no significant change in mental health treatment or self-reported unmet need. Health Homes were also associated with a 2.2 percentage point (P<.01) increase in individuals reporting excellent self-rated health, but no significant changes in hospitalizations, emergency department use, or outpatient doctor visits. The presence of SUD Home Homes specifically was associated with -1.4 percentage point (P<.05) reduction in self-reported need for SUD treatment, but presence of SMI Health Homes did not have any significant effects on utilization or unmet need. Conclusions: Statewide adoption of Health Homes for behavioral health is associated with increased SUD treatment utilization and in self-reported excellent health, but is not associated with changes in mental health treatment. Medicaid Health Homes targeting behavioral health conditions may be a promising model for addressing the low utilization of SUD treatment among Medicaid enrollees. Health Homes often provide additional screening and case management, which may be especially helpful for SUD given widespread under-diagnosis and poor care coordination. While SMI Health Homes do not have any observable effects on mental health utilization among Medicaid enrollees, it is important to examine the concentrated risk among individuals with the greatest mental health impairment.