Medicaid Lapses and Low-Income Young Adults’ Receipt of Outpatient Mental Health Care After an Inpatient Stay

Abstract

Objective This study examines low-income young adults' use of outpatient mental health services following an inpatient mental health stay, with a focus on Medicaid enrollment lapses and public mental health safety net coverage. Methods The sample included (N=1174) young adults ages 18 to 26 years who had been discharged from inpatient care in a mid-Atlantic state. All were Medicaid enrolled at the time of discharge and all were eligible for continued public mental health services regardless of Medicaid enrollment. Administrative claims data were used to examine outpatient mental health clinic use, psychotropic medication possession, inpatient readmission, and emergency department admission during the 365-day period following the index discharge. The main independent variable was a lapse in Medicaid enrollment. An instrumental variables regression model was used to minimize estimation bias due to unmeasured confounding between lapses and service use. Results Nearly a third (345 or 30%) of the young adults had an enrollment lapse. In instrumental variables analysis, those whose coverage lapsed were less likely to have had at least 2 clinic visits (38% versus 80%) and had a lower average psychotropic medication possession ratio (25% versus 55%) compared with persons who had continuous Medicaid. Conclusion Age-related Medicaid enrollment lapses are common and are associated with receipt of less clinical care post-discharge despite continued eligibility for public services. States should examine opportunities to assist young adults with serious mental health problems who are aging out of Medicaid enrollment categories for children.

A mixed-methods investigation into the perspectives on mental health and professional treatment among former system youth with mood disorders.

“…The transition to adulthood is especially complicated for youth leaving public social service systems, because they often face disrupted access to services as they exit child-serving systems, even though they remain in need (Osgood, Foster, Flanagan, & Ruth, 2005; Slade, Wissow, Davis, Abrams, & Dixon, 2014). Whereas some former system youth (i.e., those young adults who had access to public assistance facilities and treatment as children) who had been diagnosed with a mental illness during childhood experience a remission of symptoms in young adulthood, others experience a complicated period of unmet need (Courtney et al, 2011; Teplin, Welty, Abram, Dulcan, & Washburn, 2012).…”

“…The critical period of transition out of these systems presents an opportunity for interventions to improve mental health service engagement. However, it is not clear what type of interventions are needed because service discontinuation is the product of both the individual’s choice to stop treatment (McMillen & Raghavan, 2009) and disrupted access to services (Davis, 2003; Slade et al, 2014). Little is known specifically about how former system youth perceive their symptoms and diagnoses, a potential target for intervention to increase their disposition to seek formal treatment.…”

Investing in the Health and Well-Being of Young Adults

“…Among youth with mental health disorders that fall under the "other mental disorders" category (e.g., anxiety, affective, and disruptive behavior disorders)-who make up 28 percent of all children receiving SSI after reaching age 18-more than half (53 percent) lose eligibility upon redetermination (Hemmeter, 2012). Overall, these age-based criteria contribute to higher risk of Medicaid disenrollment during young adulthood, even among highly vulnerable clinical populations (Davis et al, 2014;Pullman et al, 2010), and may contribute to reduced access to needed behavioral health care (Slade et al, 2014). Although discussed here in the context of behavioral health transitions, many of these same discontinuities apply more generally to health care coverage issues for young adults.…”

Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial

“…Even if an individual wants to get care and is fully invested in treatment engagement, they may face environmental barriers. For example, one study reported that Medicaid lapses were associated with fewer clinic visits [45]. And, studies have illustrated that lack of transportation and child care are barriers to engagement among parents of young children [6].…”