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Effect of Eliminating Behavioral Health Benefits for Selected Medicaid Enrollees

Authors

  • K. John McConnell,

    1. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Mail Code CR114, 3181 SW Sam Jackson Park Rd, Portland OR 97239-3098,
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    • Address correspondence to K. John McConnell, Ph.D., Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Mail Code CR114, 3181 SW Sam Jackson Park Rd, Portland OR 97239-3098; e-mail: mcconnjo@ohsu.edu. Neal T. Wallace, Ph.D., is with the Division of Public Administration, Mark O. Hatfield School of Government, Portland State University, Portland, OR. Charles A. Gallia, Ph.D., is with the Division of Medical Assistance Programs, Human Services Department, Salem, OR. Jeanene A. Smith, M.D., M.P.H., is with the Office of Oregon Health Policy and Research, Salem, OR.

  • Neal T. Wallace,

    1. Division of Public Administration, Mark O. Hatfield School of Government, Portland State University, Portland, OR,
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  • Charles A. Gallia,

    1. Division of Medical Assistance Programs, Human Services Department, Salem, OR
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  • Jeanene A. Smith

    1. Office of Oregon Health Policy and Research, Salem, OR
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Abstract

Objective. To determine the extent to which the elimination of behavioral health benefits for selected beneficiaries of Oregon's Medicaid program affected general medical expenditures among enrollees using outpatient mental health and substance abuse treatment services.

Data Source/Study Setting. Twelve months of claims before and 12 months following a 2003 policy change, which included the elimination of the behavioral health benefit for selected Oregon Medicaid enrollees.

Study Design. We use a difference-in-differences approach to estimate the change in general medical expenditures following the 2003 policy change. We compare two methodological approaches: regression with propensity score weighting; and one-to-one covariate matching.

Principal Findings. Enrollees who had accessed the substance abuse treatment benefit demonstrated substantial and statistically significant increases in expenditures. Individuals who accessed the outpatient mental health benefit demonstrated a decrease or no change in expenditures, depending on model specification.

Conclusions. Elimination of the substance abuse benefit led to increased medical expenditures, although this offset was still smaller than the total cost of the benefit. In contrast, individuals who accessed the outpatient mental health benefit did not exhibit a similar increase, although these individuals did not include a portion of the Medicaid population with severe mental illnesses.

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