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Medicaid Coverage and Access to Publicly Funded Opiate Treatment: Oregon’s Experience NIDA/RWJ Journalist Workshop Tucson, AZ December, 2005. Dennis Deck, Wyndy Wiitala, Kathy Laws RMC Research Corporation Portland, Oregon. Acknowledgements. Funding sources NIDA R01 DA015060
Medicaid Coverage and Access to Publicly Funded Opiate Treatment:Oregon’s ExperienceNIDA/RWJ Journalist WorkshopTucson, AZDecember, 2005
Dennis Deck, Wyndy Wiitala, Kathy Laws
RMC Research Corporation
Presentation based on paper accepted for publication in J Behavioral Health Services & Research.
- Rate more than doubles despite shift to managed care. - Number served in substance abuse treatment almost quadruples.
Deck et al (2000) JAMA
Increase driven by higher retention rates despite managed care
Capped system limits access and promotes administrative discharges
Deck & Carlson (2004) JBHSR
Oregon Health Plan 2Renewal of Medicaid waiver in 2002(while state was experiencing unprecedented budget deficit and rising Medicaid costs)
OHP Standard adults admitted for opiate addiction after cut (2003) will have reduced access to methadone relative to their counterparts before cut (2002) controlling for:
Greater disenrollment among those with least ability to pay
Monthly Medicaid enrollment of adults (ages 18-64) enrolled in the OHP.
Historical (pre-2003) eligibility codes were mapped to their OHP2 equivalents.
Reflects pent up demand but not sustained due to frozen enroll-ment.
Between 2002 and 2003, a 58% decline for OHPS and 15% for OHP+ (averaging Apr-Nov)
*Monthly adult methadone admissions divided by number of adults enrolled in OHP times 1,000.
A=SA/MH benefit cut announced, E=cut takes effect, R=benefit restored but enrollment frozen
Comparison of cohorts on selected predictors with significant differences.
Old (50+ vs 25-49) 1.84
Male (vs female) .61
African Am (vs white) .41
Meth/amph problem .54
Alcohol problem .55
Yrs opiate use (Ln) 2.47
MMT in past 2 yrs 5.09
Stable eligibility 1.60
Self referral 3.68
No clinic in county .25
Not able to work .21
Group home .23
Propensity (case mix adj) .00Results (Odds Ratios) of Model Predicting Placement in MMT among Opiate Admissions
All predictors significant at p<.01 or p<.001
See also Deck & Carlson (2002)
Arrests much more likely among those with recent arrest history
Lower probability of arrestduring months in treatment, especially MMT
Descriptive analysis with no adjustment of other covariates.
HLM Level 1 model = month from admission, time varying covariate, interactions HLM Level 2 model = propensity for MMT and for Medicaid, prior arrests, cohorts
At any point, the clients in the two cohorts are well balanced on all observed covariates
Number of clients
Hypothetical Distribution of Propensity Scores Predicting 2003 Cohort
See Rosenbaum and Rubin (1984), Shadish & Clark (2002)
MMT in past 2 yrs
Live in county w/o clinic
Not able to work
Groups were defined by quintiles on the propensity score. Group 5 (highest PS) was most representative of the 2003 cohort.
Deck, D.D. , McFarland, B.H., Titus, J.M., Laws, K.E., & Gabriel, R.M. (2000). Access to substance abuse treatment . Journal of American Medical Association. 284(16), 2093–2099
Deck, D.D.; Wiitala, W.; & Laws, K. (in press). Medicaid coverage and access to publicly funded opiate treatment. Journal of Behavioral Health Services and Research.
Carlson, M.J., Gabriel, R.M., Deck, D.D., Laws, K.E., & D’Ambrosio, R. (2005). The impact of managed care on publicly funded outpatient adolescent substance abuse treatment: Service use and 6‑month outcomes in Oregon and Washington. Medical Care Research and Review, 62(3), 320-338.
Deck, D.D. & Carlson, M.J. (2005). Retention in methadone maintenance treatment in 2 western states. Journal of Behavioral Health Services & Research, 32(1), 43–60.
Deck, D.D. & Carlson, M.J. (2004). Access to publicly funded methadone maintenance treatment in two western states. Journal of Behavioral Health Services & Research, 31(2), 164–177.
Deck, D.D. & McFarland, B.H. (2002). Use of substance abuse treatment services before and after Medicaid managed care. Psychiatric Services, 53(7), 802.
McFarland, B.H., Deck, D.D., McCamant, L.E., Gabriel, R.M., & Bigelow, D.A. (in press). Outcomes for Medicaid clients with substance abuse problems before and after managed care. Journal of Behavioral Health Services and Research.
Rosenbaum P.R., Rubin D.B. (1984). Reducing bias in observational studies using subclassification on the propensity score. Journal of the American Statistical Association. 79:516-24.
Shadish, W.R., & Clark, M.H. (2002). An introduction to propensity scores. Metodologia de las Ciencias del Comportamiento Journal, 4, 291-300.