Original article
Mental Illness, Traumatic Brain Injury, and Medicaid Expenditures

https://doi.org/10.1016/j.apmr.2004.09.026Get rights and content

Abstract

Wei W, Sambamoorthi U, Crystal S, Findley PA. Mental illness, traumatic brain injury, and Medicaid expenditures.

Objective

To estimate the rates of mental illness among Medicaid beneficiaries with traumatic brain injury (TBI) and associated Medicaid-paid expenditures.

Design

Retrospective claims-based calendar year data.

Setting

Claims data.

Participants

Medicaid recipients with diagnosed TBI and mental illness who received Medicaid services in 4 states in 1995.

Interventions

Not applicable.

Main outcome measures

Annual expenditures for total, inpatient, and noninpatient services, as derived from Medicaid personal summary files. Mental illness and TBI were identified by using International Classification of Diseases, 9th Revision, Clinical Modification codes recorded in Medicaid claims.

Results

Of a total of 493,663 Medicaid recipients, 3641 (0.7%) were diagnosed with TBI in the 4 states. Significant demographic and racial differences were found in the rates of TBI; 18% of patients with TBI were diagnosed with serious mental illness. People with TBI in the age group 40 to 49 years were more likely to have a mental disorder. There were significant differences in estimated total, inpatient, and noninpatient expenditures between those with and without mental illness. In general, those with serious mental illness had higher Medicaid-paid expenditures than those without any mental illness.

Conclusions

Psychiatric comorbidity in TBI increases the overall expenditures in this population. This increased cost is an important consideration in programming for those with TBI.

Section snippets

Methods

We used the following criteria to define our study population: aged 21 to 64 years, alive by the end of 1995, and enrolled for the full-year period in Medicaid. We excluded people who participated in managed care programs because these claims are not recorded in the SMRF files. We selected 4 states based on geographic diversity and limited penetration of Medicaid managed care. We identified 493,663 beneficiaries, of whom 96,866 were in Alabama, 186,875 were in Georgia, 128,887 were in New

Characteristics of study population

Table 1 describes the combined study population from all 4 states. The overall population was 64% female, 38% white, 30% African American, 2% Hispanic, and 30% other races. (The category of “other” included the unknown and the missing responses, making interpretation of the “other” response difficult.) Thirty-three percent of the combined population lived in Georgia, followed by New Jersey (31%). Eighty-three percent had qualified for Medicaid because of permanent disability. Almost two thirds

Discussion

Our study used a dataset of Medicaid claims from 4 states. Such a dataset is uniquely suited to examine patterns of expenditures for those with TBI and mental illness, in an effort to gain better understanding of the impact of a psychiatric comorbidity on the care and the related costs, for these people. Use of claims data allows the tracking of claims across time without the active participation of the patient to provide information. This style of data collection is well suited for those with

Conclusions

This study found that expenditures, although variable across service types, are generally higher for those with TBI and SMI. This suggests the overall need for general awareness that the expenditures for the dual diagnosis are higher than for TBI alone, and that this be considered in programming and budget planning, particularly for tightly budgeted programs like the state Medicaid programs.

Acknowledgment

We acknowledge Ann Bagchi, PhD, for her assistance in reading the data.

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    Supported in part by the Public Health Service (grants no. P-30 MH 43450, R01 MH 60831, P20 MH 11825). The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other organizations.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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    Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.