Enrollment under the Medicaid Expansion and Health Insurance Exchanges. A Focus on Those with Behavioral Health Conditions in Michigan

Transcription

1 Enrollment under the Medicaid Expansion and Health Insurance Exchanges A Focus on Those with Behavioral Health Conditions in Michigan

2 Methods for Estimating Uninsured with M/SU Conditions by FPL From NSDUH, identified by State the number of uninsured persons aged with income: Between 133% and 400% of the Federal poverty level (FPL) eligible for health insurance exchanges Less than 139% of the FPL eligible for Medicaid expansion Calculated NSDUH prevalence rates for serious mental illness (SMI) and substance use disorder (SUD) by State, for the above groups Applied SMI/SUD prevalence rates to American Community Survey counts of uninsured by State 3

3 Data Sources National Survey on Drug Use and Health Sponsored by SAMHSA National and state estimates on prevalence of behavioral health conditions and treatment data Approximately 67,500 interviews per year American Community Survey Sponsored by the U.S. Bureau of the Census National and State population estimates, including counts of uninsured by income level 2010 data Approximately 1.9 million persons in sample 2

4 Prevalence of Serious Mental Illness Among Adults Ages by Current Medicaid Status and Eligibility for Medicaid Expansion or Health Insurance Exchanges: Michigan, US 16% 14% 12% Prevalence Rate 10% 8% 6% 4% 2% 0% 11.7% 11.6% 7.0% 9.5% 6.0% 6.2% Current Medicaid Population (Michigan: 715,204) MI CI: 9.2% % U.S. CI: 10.8% % Medicaid Expansion Population (Michigan: 529,406) MI CI: 6.9% % U.S. CI: 6.3% - 7.7% Health Insurance Exchange Population (Michigan: 514,600) MI CI: 4.3% - 8.7% U.S. CI: 5.5% - 6.6% I National Michigan Confidence Interval 4 CI = Confidence Interval

5 Prevalence of Serious Psychological Distress Among Adults Ages by Current Medicaid Status and Eligibility for Medicaid Expansion or Health Insurance Exchanges: Michigan, US 35% 30% Prevalence Rate 25% 20% 15% 10% 5% 0% 22.1% 24.5% 14.9% 19.9% 13.3% 14.8% Current Medicaid Population (Michigan: 715,204) MI CI: 20.5% % U.S. CI: 21% % Medicaid Expansion Population (Michigan: 529,406) MI CI: 15.9% % U.S. CI: 14% % Health Insurance Exchange Population (Michigan: 514,600) MI CI: 11.5% % U.S. CI: 12.5% % I National Michigan Confidence Interval 5 CI = Confidence Interval

6 Prevalence of Substance Use Disorders Among Adults Ages by Current Medicaid Status and Eligibility for Medicaid Expansion or Health Insurance Exchanges: Michigan, US 25% 20% Prevalence Rate 15% 10% 5% National Michigan I Confidence Interval 0% 12.4% 12.4% 14.2% 16.9% 14.6% 17.1% Current Medicaid Population (Michigan: 715,204) MI CI: 9.5% - 16% U.S. CI: 11.5% % Medicaid Expansion Population (Michigan: 529,406) MI CI: 13.7% % U.S. CI: 13.2% % Health Insurance Exchange Population (Michigan: 514,600) MI CI: 13.9% % U.S. CI: 13.7% % 6 CI = Confidence Interval

7 Prevalence of Behavioral Conditions Among Health Insurance Exchange Population: Michigan, US 25% Uninsured Adults Ages with Incomes Between % of the Federal Poverty Level (Michigan: 514,600) Prevalence Rate 20% 15% 10% 5% 0% 6.0% 6.2% 13.3% 14.8% 14.6% 17.1% Serious Mental Illness MI CI: 4.3% - 8.7% U.S. CI: 5.5% - 6.6% Serious Psychological Distress MI CI: 11.5% % U.S. CI: 12.5% % Substance Use Disorder MI CI: 13.9% % U.S. CI: 13.7% % I National Michigan Confidence Interval 7 CI = Confidence Interval

8 Prevalence of Behavioral Conditions Among Medicaid Expansion Population: Michigan, US 30% Uninsured Adults Ages with Incomes < 139% of the Federal Poverty Level (Michigan: 529,406) 25% Prevalence Rate 20% 15% 10% 5% 0% 7.0% 9.5% 14.9% 19.9% 14.2% 16.9% Serious Mental Illness MI CI: 6.9% % U.S. CI: 6.3% - 7.7% Serious Psychological Distress MI CI: 15.9% % U.S. CI: 14% % Substance Use Disorder MI CI: 13.7% % U.S. CI: 13.2% % I National Michigan Confidence Interval 8 CI = Confidence Interval

9 Methods for Estimating Population Characteristics From NSDUH, calculated the national prevalence rates for SMI, serious psychological distress (SPD), and SUD by income group with demographic populations of interest (e.g., uninsured non-hispanic whites with income <138% FPL with SMI) Multiplied national prevalence rate by the ACS State population by income group with this demographic characteristic (e.g., national % of uninsured year olds with income <138% FPL with SMI * ACS State number of year olds with income <138% FPL) Calculated the percent distribution with condition in the State across demographic groups such as race, age, and education (e.g., percent with SMI with < high school, high school, or college education) 9

10 Characteristics of Year-Olds with a Serious Mental Illness (SMI) Projected in Medicaid Expansion Population* National Michigan Female 61% 57% Age % 52% Race/Ethnicity Non-Hispanic White 66% 81% Non-Hispanic Black 13% 13% Other 5% 2% Hispanic 16% 4% Education < High School 26% 16% High School Graduate 38% 40% College 37% 43% Most common characteristics of persons with SMI in Medicaid expansion population in Michigan are: Non-Hispanic White College Graduate * Population with income less than 139% of the Federal Poverty Level and uninsured 10

11 Characteristics of Year-Olds with a Substance Use Disorder (SUD) Projected in Medicaid Expansion Population* National Michigan Male 75% 78% Age % 61% Race/Ethnicity Non-Hispanic White 51% 70% Non-Hispanic Black 20% 22% Other 4% 2% Hispanic 25% 7% Education < High School 37% 25% High School Graduate 32% 37% College 31% 39% Most common characteristics of persons with SUD in Medicaid expansion population in Michigan are: Male years old Non-Hispanic White or Black * Population with income less than 139% of the Federal Poverty Level and uninsured 11

12 Characteristics of Year-Olds with a Serious Mental Illness (SMI) Projected in Health Insurance Exchange* National Michigan Female 60% 59% Age % 56% Race/Ethnicity Non-Hispanic White 68% 87% Non-Hispanic Black 10% 9% Other 5% 1% Hispanic 17% 3% Education < High School 18% 10% High School Graduate 38% 40% College 44% 51% Most common characteristics of persons with SMI in exchange population in Michigan are: Non-Hispanic White College Graduate * Population with income from 133% to 399% of the Federal Poverty Level and uninsured 12

13 Characteristics of Year-Olds with a Substance Use Disorder (SUD) Projected in Health Insurance Exchange* National Michigan Male 73% 74% Age % 69% Race/Ethnicity Non-Hispanic White 52% 78% Non-Hispanic Black 14% 14% Other 5% 2% Hispanic 29% 6% Education < High School 26% 15% High School Graduate 38% 42% College 36% 43% Most common characteristics of persons with SUD in exchange population in Michigan are: Male years old Non-Hispanic White College Graduate * Population with income from 133% to 399% of the Federal Poverty Level and uninsured 13