Medicaid populations with chronic and disabling conditions : a compilation of data on their characteristics, health conditions, service use, and Medicaid payments : final report

2007·4 MB·English

by  Irvin, Carol V

ContractNo.: 500-00-0047(01) MATHEMATICA
MPRReferenceNo.: 8764-300
PolicyResearch,Inc.
MedicaidPopulations
withChronicand
DisablingConditions:A
CompilationofDataon
TheirCharacteristics,
HealthConditions,
ServiceUse,and
MedicaidPayments
FinalReport
March16,2007
CarolV.Irvin
ChristopherJohnson
Submittedto: Submittedby:
U.S.DepartmentofHealthandHumanServices MathematicaPolicyResearch,Inc.
CentersforMedicare&MedicaidServices 955MassachusettsAve.,Suite801
C3-19-07CentralBuilding Cambridge,MA02139
B7a5l0t0imSoerceu,riMtyDBl2v1d2.44-1850 TFaeclseipmhiolnee::((661177))449911--87094040
ProjectOfficer: ProjectDirector:
JimHawthorne CarolIrvin
.
CONTENTS
Chapter Page
I INTRODUCTION 1
II DATAANDMETHODS 3
A. DATA 3
1. MedicaidAnalyticalExtractSystem 3
2. SocialSecurityAdministrationRecords 3
B. METHODS 4
1 IdentificationofEnrolleeswithChronicandDisablingConditions 4
2. IdentificationResults 5
3. Tabulations 10
C. DATALIMITATIONS 14
1. ManagedCare 14
2. EnrolleesDuallyEligibleforMedicareandMedicaid 15
3. PreventiveCare 16
4. PsychiatricServices 16
D. MEDICAIDENROLLEESRECEIVINGFEDERALDISABILITY
BENEFITS 17
1. LinkingMedicaidandSSARecords 17
2. Tabulations 21
III CHILDRENWITHCHRONICANDDISABLINGCONDITIONS 23
IV WORKINGAGEADULTSWITHCHRONICANDDISABLING
CONDITIONS 46
V YOUNGADULTRECIPIENTSOFSUPPLEMENTALSECURITYINCOME
BENEFITS 69
VI WORKINGAGEADULTSSIRECIPIENTSANDSSDIBENEFICIARIES 82
REFERENCES 98
APPENDIXA: CHRONICILLNESSANDDISABILITYPAYMENTSYSTEM
SAMPLEDIAGNOSES,BYCONDITIONCATEGORY
11
1
TABLES
Table Page
n.l NUMBEROFMEDICAIDENROLLEESWITHCHRONICANDDISABLING
CONDITIONSANDPERCENTAGEINFEEFORSERVICE,OVERALLAND
BYSTATECALENDARYEARS1999AND2000 7
U2 MEDICAIDELIGIBILITYCATEGORIES 1
n.3 RESULTSOFTHEMEDICAID-TICKETRESEARCHDATAFILELINK,
BYMEDICAIDELIGIBILITYCATEGORYANDAGEGROUP 19
111.1 DEMOGRAPHICCHARACTERISTICSOFMEDICAIDCHILDREN
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE
CALENDARYEARS1999AND2000 25
111.2 MEDICAIDELIGIBILITYCATEGORIESOFMEDICAIDCHILDREN
WITHCHRONICANDDISABLINGCONDITIONSINFEEFOR
SERVICECALENDARYEARS1999AND2000 26
III.3.1 CAHNRDODNIISCACBOLNINDGITCIOONNDSITOIFOMNESDIINCFAEIEDFCOHRILSDERREVNICWEICTAHLCEHNRDOANRIC
YEARS1999AND2000 27
111.3.2 CHRONICCONDITIONSOFMEDICAIDCHILDRENWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BY
CHRONICCONDITIONCATEGORYANDBYGENDERANDAGE
GROUPCALENDARYEAR2000 28
111.3.3 CHRONICCONDITIONSOFMEDICAIDCHILDRENWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BY
DISABILITYSTATUSCALENDARYEARS1999AND2000 29
111.3.4 CHRONICCONDITIONSOFMEDICAIDCHILDRENWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BYCHRONIC
CONDITIONCATEGORYANDBYMEDICAIDELIGIBILITYGROUP
CALENDARYEAR2000 30
111.4.1 COMORBIDITIESOFMEDICAIDCHILDRENWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICECALENDAR
YEARS1999AND2000 31
111.4.2 COMORBIDITIESOFMEDICAIDCHILDRENWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BYGENDERAND
AGEGROUPCALENDARYEAR2000 32
iii
6
TABLES(continued)
Table Page
111.4.3 COMORBIDITIESOFMEDICAIDCHILDRENWITHCHRONICAND
DISABLINGCONDITIONSINFEEFORSERVICECALENDARYEARS1999
AND2000 33
111.4.4 COMORBIDITIESOFMEDICAIDCHILDRENWITHCHRONICAND
DISABLINGCONDITIONSINFEEFORSERVICE,BYMEDICAID
ELIGIBILITYCATEGORYCALENDARYEAR2000 34
111.5 PRIMARYCARE,ACUTECARE,ANDSUPPORTANDREHABILITATIVE
SERVICEUSEBYMEDICAIDCHILDRENWITHCHRONICAND
DISABLINGCONDITIONSINFEEFORSERVICECALENDARYEARS
1999AND2000 35
111. INPATIENTSERVICEUSEBYMEDICAIDCHILDRENWITHCHRONICAND
DISABLINGCONDITIONSINFEEFORSERVICECALENDARYEARS1999
AND2000 36
111.7 LONG-TERMCARESERVICEUSEBYMEDICAIDCHILDRENWITH
CHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE
CALENDARYEARS1999AND2000 37
111.8 TOTALANNUALMEDICAIDPAYMENTS(INTHOUSANDS)FORMEDICAID
CHILDRENWITHCHRONICANDDISABLINGCONDITIONSINFEEFOR
SERVICECALENDARYEARS1999AND2000 38
111.9 AVERAGEANNUALMEDICAIDPAYMENTSFORMEDICAIDCHILDREN
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE
CALENDARYEARS1999AND2000 40
111.10 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDCHILD
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
OVERALLANDBYDEMOGRAPHICCHARACTERISTICCALENDAR
YEARS1999AND2000 42
III.l1 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDCHILD
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYMEDICAIDELIGIBILITYCATEGORYCALENDARYEARS1999
AND2000 43
III.12 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDCHILD
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYCHRONICCONDITIONCATEGORYCALENDARYEARS1999
AND2000 44
iv
TABLES(continued)
Table Page
III.13 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDCHILD
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYNUMBEROFCOMORBIDITIESCALENDARYEARS1999AND2000 45
IV.I DADEUMLOTGSRAWPIHTIHCCCHHRAORNAICCTEARNIDSTDIICSASBOLFINMGEDCIOCNADIIDTIWOONRSKIINNFGEEAGE
FORSERVICECALENDARYEARS1999AND2000 48
IV.2 MEDICAIDELIGIBILITYCATEGORIESOFMEDICAIDWORKINGAGE
ADULTSWITHCHRONICANDDISABLINGCONDITIONSINFEE
FORSERVICECALENDARYEARS1999AND2000 49
IV.3.1 CCHHRROONNIICCCAONNDDIDTISIAOBNLSIONFGMCEODNIDCIATIIDONWSOIRNKFIENEGFAOGRESAERDVUILCTESWITH
CALENDARYEARS1999AND2000 50
IV.3.2 CHRONICCONDITIONSOFMEDICAIDWORKINGAGEADULTSWITH
CHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYCONDITIONCATEGORYANDBYGENDERANDAGEGROUP
CALENDARYEAR2000 51
IV.3.3 CHRONICCONDITIONSOFMEDICAIDWORKINGAGEADULTSWITH
CHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYDISABILITYSTATUSCALENDARYEARS1999AND2000 52
IV.3.4 CHRONICCONDITIONSOFMEDICAIDWORKINGAGEADULTSWITH
CHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE,
BYCHRONICCONDITIONCATEGORYANDBYMEDICAIDELIGIBILITY
GROUPCALENDARYEAR2000 53
IV.4.1 COMORBIDITIESOFMEDICAIDWORKINGAGEADULTSWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICECALENDARYEARS
1999AND2000 54
IV.4.2 COMORBIDITIESOFMEDICAIDWORKINGAGEADULTSWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BYGENDERAND
AGEGROUPCALENDARYEAR2000 55
IV.4.3 COMORBIDITIESOFMEDICAIDWORKINGAGEADULTSWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICECALENDARYEARS
1999AND2000 56
TABLES(continued)
Table Page
IV.4.4 COMORBIDITIESOFMEDICAIDWORKINGAGEADULTSWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICE,BYMEDICAID
ELIGIBILITYCATEGORYCALENDARYEAR2000 57
IV.5 PRIMARYCARE,ACUTECARE,ANDSUPPORTANDREHABILITATIVE
SERVICEUSEBYMEDICAIDWORKINGAGEADULTSWITHCHRONIC
ANDDISABLINGCONDITIONSINFEEFORSERVICECALENDAR
YEARS1999AND2000 58
IV.6 INPATIENTSERVICEUSEBYMEDICAIDWORKINGAGEADULTSWITH
CHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE
CALENDARYEARS1999AND2000 59
IV.7 LONG-TERMCARESERVICEUSEBYMEDICAIDWORKINGAGEADULTS
WITHCHRONICANDDISABLINGCONDITIONSINFEEFORSERVICE
CALENDARYEARS1999AND2000 60
IV.8 TOTALANNUALMEDICAIDPAYMENTS(INTHOUSANDS)FORMEDICAID
WORKINGAGEADULTSWITHCHRONICANDDISABLINGCONDITIONS
INFEEFORSERVICE,CALENDARYEARS1999AND2000 61
IV.9 AVERAGEANNUALMEDICAIDPAYMENTSFORMEDICAIDWORKING
AGEADULTSWITHCHRONICANDDISABLINGCONDITIONSIN
FEEFORSERVICE,CALENDARYEARS1999AND2000 63
IV.10 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDWORKING
AGEADULTWITHCHRONICANDDISABLINGCONDITIONSINFEE
FORSERVICE,OVERALLANDBYDEMOGRAPHICCHARACTERISTIC
CALENDARYEARS1999AND2000 65
IV.11 AAGVEERAADGUELTMOWNITTHHLCYHRMOENDIICCAAINDDPDAIYSMAEBNLTINSGPCEORNMDEIDTIICOANISDINWOFREEKING
FORSERVICE,BYMEDICAIDELIGIBILITYCATEGORYCALENDARYEARS
1999AND2000 66
IV.12 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDWORKING
AGEADULTWITHCHRONICANDDISABLINGCONDITIONSINFEE
FORSERVICE,BYCHRONICCONDITIONCATEGORYCALENDAR
YEARS1999AND2000 67
VI
11
TABLES(continued)
Table Page
IV.13 AVERAGEMONTHLYMEDICAIDPAYMENTSPERMEDICAIDWORKING
AGEADULTWITHCHRONICANDDISABLINGCONDITIONSINFEE
FORSERVICE,BYNUMBEROFCOMORBIDITIESCALENDARYEARS
1999AND2000 68
V.l SUPPLEMENTALSECURITYINCOME(SSI)RECIPIENTS18THROUGH2
YEARSOFAGEINFEEFORSERVICECALENDARYEARS1999AND
2000(WEIGHTED) 71
V2 SUPPLEMENTALSECURITYINCOME(SSI)RECIPIENTS18THROUGH21
YEARSOFAGEINFEEFORSERVICE BYGENDERCALENDAR
YEARS1999AND2000(WEIGHTED) , 72
V.3 PRIMARYDISABLINGCONDITIONSOFSSIRECIPIENTS18THROUGH2
YEARSOFAGEINFEEFORSERVICECALENDARYEARS1999AND
2000(WEIGHTED) 73
V.4 CAHGREOINNIFCECEOFNODRITSIEORNVSICOEFCSASILERENCDIAPRIEYNETASR1S8T19H9R9OAUNGDH202010YEARSOF
(WEIGHTED) 74
V^ CFOEEMOFROBRIDSIETRIVEISCEOCFASLSIERNEDCAIRPIYEENATRSS1819T9H9RAONUDG2H00201(YWEEAIRGSHTOEFDA)GEIN 75
V.6 CHRONICCONDITIONSOFSSIRECIPIENTS18THROUGH21YEARSOF
AGEINFEEFORSERVICE,BYPRIMARYDISABLINGMENTALHEALTH
CONDITIONCALENDARYEAR2000(WEIGHTED) 76
V.7 CHRONICCONDITIONSOFSSIRECIPIENTS18THROUGH21YEARSOF
AGEINFEEFORSERVICE,BYPRIMARYDISABLINGPHYSICALHEALTH
CONDITIONCALENDARYEAR2000(WEIGHTED) 77
V.8 PRIMARYCARE,ACUTECARE,ANDSUPPORTANDREHABILITATIVE
SERVICEUSEBYSSIRECIPIENTS18THROUGH21YEARSOFAGEINFEE
FORSERVICE,BYTYPEOFSERVICECALENDARYEARS1999AND
2000(WEIGHTED) 78
V.9 INPATIENTSERVICEUSEBYSSIRECIPIENTS18THROUGH21YEARSOF
AGEINFEEFORSERVICECALENDARYEARS1999AND2000
(WEIGHTED) 79
vu
TABLES(continued)
Table Page
V.IO LONG-TERMCARESERVICEUSEBYSSIRECIPIENTS18THROUGH21
YEARSOFAGEINFEEFORSERVICE,BYTYPEOFSERVICECALENDAR
YEARS1999AND2000(WEIGHTED) 80
V.l1 ANNUALMEDICAIDPAYMENTSPERSSIRECIPIENT18THROUGH21
YEARSOFAGEINFEEFORSERVICE,OVERALLANDBYTYPEOF
SERVICECALENDARYEARS1999AND2000(WEIGHTED) 81
VI.1 PARTICIPATIONINFEDERALDISABILITYPROGRAMSBYMEDICAID
WORKINGAGEADULTSWITHCHRONICORDISABLINGCONDITIONS
INFEEFORSERVICECALENDARYEARS1999AND2000(WEIGHTED) 84
VI.2 PROGRAMPARTICIPATIONCHARACTERISTICSOFMEDICAIDWORKING
AGESSIANDSSDIENROLLEESINFEEFORSERVICE,BYFEDERAL
DISABILITYBENEFITPROGRAMCALENDARYEAR2000(WEIGHTED) 85
VI.3 DEMOGRAPHICCHARACTERISTICSOFMEDICAIDWORKINGAGESSI
ANDSSDIENROLLEESINFEEFORSERVICE,BYFEDERALDISABILITY
BENEFITPROGRAMCALENDARYEAR2000(WEIGHTED) 86
VI.4 MEDICAIDELIGIBILITYOFMEDICAIDWORKINGAGESSIANDSSDI
ENROLLEESINFEEFORSERVICE,BYFEDERALDISABILITYBENEFIT
PROGRAMCALENDARYEAR2000(WEIGHTED) 87
VI.5 PRIMARYDISABLINGCONDITIONSOFMEDICAIDWORKINGAGESSI
ANDSSDIENROLLEESINFEEFORSERVICE,BYFEDERALDISABILITY
BENEFITPROGRAMCALENDARYEAR2000(WEIGHTED) 88
VI.6 CHRONICCONDITIONSOFWORKINGAGESSIRECIPIENTSINFEEFOR
SERVICECALENDARYEARS1999AND2000(WEIGHTED) 89
VI.7 COMORBIDITIESOFWORKINGAGESSIRECIPIENTSINFEEFOR
SERVICECALENDARYEARS1999AND2000(WEIGHTED) 90
VI.8 CHRONICCONDITIONSOFWORKINGAGESSIRECIPIENTSINFEEFOR
SERVICE,BYPRIMARYDISABLINGMENTALHEALTHCONDITION
CALENDARYEAR2000(WEIGHTED) 91
VI.9 CHRONICCONDITIONSOFWORKINGAGESSIRECIPIENTSINFEEFOR
SERVICE,BYPRIMARYDISABLINGPHYSICALHEALTHCONDITION
CALENDARYEAR2000(WEIGHTED) 93
Vlll
TABLES(continued)
Table Page
VI.10 PRIMARYCARE,ACUTECARE,ANDSUPPORTANDREHABILITATIVE
SERVICEUSEBYWORKINGAGESSIRECIPIENTSINFEEFORSERVICE
CALENDARYEARS1999AND2000(WEIGHTED) 94
VI.11 SIENPRAVTIICEENCTASLEERNVDICAERUYSEEABRSYW19O9R9KAINNDG2A00G0E(SWSEIIRGEHCTIEPDI)ENTSINFEEFOR95
VI.12 LONG-TERMCARESERVICEUSEBYWORKINGAGESSIRECIPIENTSIN
FEEFORSERVICECALENDARYEARS1999AND2000(WEIGHTED) 96
VI.13 ANNUALMEDICAIDPAYMENTSPERWORKINGAGESSIRECIPIENTIN
FEEFORSERVICE,OVERALLANDBYTYPEOFSERVICECALENDAR
YEARS1999AND2000 97
A.l CHRONICILLNESSANDDISABILITYPAYMENTSYSTEMSAMPLE
DIAGNOSESBYCONDITIONCATEGORY A.2
IX
I.INTRODUCTION
ConcernovertheabilityofMedicaidprogramstomeettheneedsofenrolleeswithchronic
and disabling conditions has intensified as more Medicaid recipients receive care through
managed care organizations and as state fiscal constraints have focused attention on rising
Medicaidcosts. AlthoughinformationaboutthehealthcareutilizationandMedicaidcostsof
people with special health care needs is limited, in part because ofthe difficulty offully
identifyingthispopulationinMedicaidclaimsandenrollmentdata,weknowtheytypicallyuse
healthcare servicesmore intensivelyandtheirservicesaremorecostlythanthoseofother
enrollees. Inaddition,theyareadiversepopulation: theyhaveadiversityofconditionsthat
resultinadiversityofneeds,andtheyareservedinadiversityofsettings.
Definitionsofthepopulationwithspecialhealthcareneedsvary. Thenearly 13million
peoplewhoareblindordisabledandreceivefederaldisabilitybenefitsthroughtheSupplemental
SecurityIncome(SSI)andSocialSecurityDisabilityInsurance(SSDI)programsaretypically
defined asone such population (Social Security Administration 2005a, 2005b). Thesetwo
programsprovidecashbenefitstopeoplewhoareseverelydisabled. Applicantsmustshowthat
theirdisabilitiesaretotal,willlastatleast12monthsorresultindeath,andpreventthemfrom
earningaliving. Butthereareothergroupswithchronicanddisablingconditions,andthe
Medicaidprogramservesnumerouspeoplewithspecialhealthcareneedswhodonotreceive
federaldisabilitybenefits.
TheCentersforMedicare&MedicaidServices(CMS)contractedwithMathematicaPolicy
Research,Inc.(MPR)toidentifythegeneralMedicaidpopulationwithspecialhealthcareneeds
andexaminetheirwiderangeofchronicanddisablingconditions(CMSContractNumber500-
00-0047[01]). Toaccomplishthiswork,MPRobtainedMedicaideligibilityandclaimsrecords
1