NIMH » Medicaid Data Shows Big Differences in U.S. Mental Health Care

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Administered by the Centers for Medicare and Medicaid Services, the Medicaid program provides health care to millions of Americans, including eligible low-income adults, children, pregnant women, the elderly, and the disabled. Because the program is a state-federal partnership, its implementation can vary greatly from state to state. A new study, sponsored by the National Institute of Mental Health, reveals significant differences in mental health care rates among Medicaid participants based on where they live in the United States.

Dr. K. John McConnell of Oregon Health and Science University and colleagues examined data from millions of Americans aged 19 to 64 who enrolled in Medicaid in 2018. This study is the first to extensively use a new database of nationwide Medicaid claims. , known as Transformed Medicaid Statistical Information System Analytic Files, are designed to provide reliable, anonymized data for research purposes.

The database contained data for 42 states and Washington, DC, but excluded states with significantly missing or incomplete data. Researchers divided states into 393 economic regions. This is a group of counties within a state with a population of at least 100,000 and similar socioeconomic characteristics. For each economic sector, researchers calculated the number of emergency department visits for mental health conditions and the number of mental health outpatient visits. They used emergency department visits as a proxy for access to and quality of outpatient mental health care, assuming that people turn to the emergency room when outpatient mental health services are inaccessible or face shortages. Did.

Medicaid billing showed variability in rates of emergency department visits for mental health conditions between states and between economic regions within states. For example, states with the most emergency department visits had almost five times as many visits as states with the least visits. Similarly, many states had wide ranges between economic areas with the highest and lowest numbers of emergency department visits.

There was also significant geographic variation in mental health outpatient visits, which was positively correlated with emergency department visits, but only moderately. In general, economies with higher rates of emergency department visits also had higher rates of outpatient care. However, some regions had high rates of emergency department visits but low rates of mental health outpatient visits, and vice versa. Frequent use of emergency services for mental health treatment may reflect high need in those areas and, in the absence of available outpatient treatment, high unmet need. may reflect the

As a final step, researchers compared emergency department visits for specific types of mental health conditions.

  • Anxiety disorders compared to schizophrenia and other psychotic disorders
  • Depressive disorders compared with suicidal ideation and intentional self-harm

Emergency department visits vary by condition. For example, ED visits were higher for schizophrenia, but relatively lower for anxiety, in economic regions made up of large cities. Smaller cities, by contrast, were more likely to visit because of anxiety. For the clinically relevant symptoms of depression and suicidal ideation, rates of emergency department visits were also not uniform across regions. These results show that combining various mental health conditions can mask significant differences in the number or type of services received by Medicaid participants for specific conditions.

Together, the findings highlight national use of emergency departments for mental health care, while also highlighting wide variations in rates of use between states and among mental disorders. The frequent use of emergency services for mental health care demonstrated in this study indicates, in some cases, high unmet need or lack of access to outpatient mental health services. There is a possibility that

Regional differences in the mental health care experience of Medicaid recipients also demonstrate the importance of strategies that are tailored to specific populations. The authors emphasize the need for contextual and local solutions. Its solutions include examining how mental health benefits are administered by state Medicaid agencies, determining the availability of mental health providers in your community, and providing the most common types of health care in your community. It may start by identifying a mental disorder. .

Since this is a new database, there are some considerations to be aware of. First, eight states were not included in the analysis due to missing or incomplete data. Second, databases provide limited information on disparities in care received by people of different races and ethnicities. Third, a subset of the Medicaid population (those eligible for both Medicaid and Medicare) who are particularly likely to face barriers to care were excluded from the analysis. Finally, regional differences in coding mental health diagnoses and submitting mental health claims may have led to underreporting in some regions. As these Medicaid files become more widely used, improvements in data quality and the addition of more common data elements may help overcome these limitations.

Initial analyzes using this new database demonstrate the value of large-scale national data for understanding trends in diagnosis, service utilization, and mental health. The study also identified limitations that state administrators, data analysts, and others would like to address. These files are more comprehensive and reliable than previous Medicaid claims data, but further research may provide additional insight into their quality and consistency. Future research and policy implementation will leverage nationally representative data to improve the quality and value of Medicaid mental health programs, thereby improving mental health outcomes for millions of Americans nationwide. can be improved.


McConnell, KJ, Watson, K., Choo, E., and Zhu, JM (2023). Geographic Variation in Emergency Department Visits for Mental Health Conditions in Medicaid Recipients. health problems, 42(2), 172–181.


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