Healthcare utilization of individuals with opiate use disorders: an analysis of integrated medicaid and state mental health/substance abuse agency data.

Data from the Substance Abuse and Mental Health Services Administration's Integrated Database (IDB) were used to examine the service use patterns of individuals with possible opiate use disorders in Washington State. Results indicate that regardless of Medicaid enrollment status, individuals who received mental health (MH) or substance abuse (SA) services only through state agencies received no inpatient substance abuse service. Furthermore, when compared with individuals who received at least one MH/SA service through Medicaid, those who received services only through the state agencies were less likely to have received any MH services and were more likely to have received residential SA services. This analysis highlights the importance of using integrated client data in providing a more comprehensive understanding of services to inform policy and raises significant questions about how regulatory requirements affecting different funding mechanisms might drive settings of care in ways not related to the care needed.

Mental health and substance abuse treatment utilization among individuals served by multiple public agencies in 3 states.

Patterns of mental health (MH) and substance abuse (SA) treatment utilization among populations receiving services through multiple public programs are not well known. This study examines to what extent populations with MH and/or SA conditions utilize treatment services through Medicaid and State MH/SA Agencies. Data are from the Substance Abuse and Mental Health Services Administration Integrated Database, a multiyear file for 3 states combining Medicaid and State MH/SA Agency administrative data into a uniform database. Although populations with co-occurring conditions and those served by both Medicaid and State MH/SA Agencies have substantial contact with the public treatment system, a majority of the MH/SA populations examined here utilize few services over brief periods of time. Utilization is most limited among individuals with MH-only conditions and those served exclusively by Medicaid. While a lack of data on clinical outcomes prevents us from drawing conclusions about the effectiveness of MH/SA services, results of this analysis indicate that public programs in the states examined here do not provide services that are primarily utilized on a frequent or chronic basis.

Utilization of public mental health services by adults with serious mental illness.

Public mental health (MH) services were examined for non-elderly adults with serious mental illness (SMI) using a database combining information from Medicaid, MH, and substance abuse agencies in three states. These data show that between 23% and 39% of those with SMI received MH services only through Medicaid. Relative use of community versus state hospitals for delivery of psychiatric inpatient care varied across the three states. However, state hospitals accounted for a large proportion of total inpatient days, due to high mean annual days of care. In two states, Medicaid paid for fewer psychiatric inpatient days than expected.

Utilization of public mental health services by children with serious emotional disturbances.

The Integrated Database (IDB) was created to provide a broad picture of the use of state-funded mental health (MH) and substance abuse (SA) services. Assembled separately for three states (Delaware, Oklahoma, and Washington), the IDB links client-level and service-level data maintained by the state MH, SA, and Medicaid agencies. This study used the IDB to examine public MH services for children with serious emotional disturbances (SED) in 1996. Children with SED represented 9% to 22% of all children with MH service use. Between one half and two thirds of children with SED received psychotropic medication; 20% to 40% had a MH inpatient or residential stay. Medicaid was the primary funder of MH services for children with SED; only 2% to 12% of children with SED received services solely through the state MH agency.