Table Of Content

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