Disparities in Medicaid Utilization and Expenditures

1
Disparities in Medicaid Utilization and
Expenditures

• between
• American Indians
• and non-Indians
• in California

2
collaborative effort of the California Rural
Indian Health Board Indian Health Services
(Albuquerque) California Department of Health
Services Institute for Health Policy Studies,
UCSF funded by the Kaiser Family Foundation
3
Policy Issue

• What are equitable
• Medicaid payments for
• American Indians/Alaska Natives (AI)?

4
Study Question
How do health care use and costs for rural
Medicaid eligible AI differ from comparable
non-AI?
5
AI Population in rural California areas

• 115,000 live in rural areas on or near American
  Indian lands
• More than 103 federally recognized indigenous
  tribes
• 309,000 AI within state borders of any
  recognized tribe

as of 1995
6
Health Service Providers in rural California
areas

• Indian Health Programs (27)
• federally qualified clinics
• 83 of rural AI registered
• 56 of registered AI use in 3 years
• Eligible AI can use any Medicaid provider
• Eligible non-AI can use Indian clinics

7
Matched Samples AI nonAI

• 1995 1996 Indian Health Service files of AI
  Users for the 25 of the 27 rural Indian Health
  Programs
• linked by CA Dept of Health Services to FFY1996
  Medicaid eligibility paid claims files by SSN
• non-AI whites matched 21 for age, gender, Aid
  Code, county and months of eligibility

8
IHS Users and Indian Medicaid Eligible Ages

• IHS Users
• 43,482
• lt 18 37
• 19-44 yrs 43
• 45-64 yrs 14
• gt65 yrs 6

• Medicaid Eligibles
• 10,317
• 58
• 32
• 6
• 4

9
Eligibles Ages
10,317
20,416
10
Eligibles Gender
10,317
20,416
11
Eligibles Aid Codes
12
Eligibles Length of Eligibility
Mean 6.2 months 5.9
months Median 6 months 6
months
13
Results Usual Source of Care Among Medicaid Users
14
Results Median Medicaid Payments per User
plt.001 tplt.05
15
Conclusion

• Medicaid spends less on California Area Indians
  who use Tribal Health Programs than comparable
  non-Indians

16
Policy Implication

• These results will be used by CRIHB to advocate
  for more equitable Medicaid services for
  California Area Indians.

17
Next stepsMultivariate Regressions

• Independent variable
• Indian vs. non-Indian
• Control variable types
• Matched characteristics
• Usual Source of Care
• Case mix severity

18
Dependent Variables

• Health Care Use Costs
• Visits
• Prescriptions
• Hospital Stays
• Emergency Room visits
• Total Medicaid Payments