July 12, 2007

Treatment Admissions with Medicaid as the Primary Expected or Actual Payment Source: 2005

The Medicaid program is a significant source of payment for Americans seeking substance abuse treatment. For example, Medicaid may cover detoxification, rehabilitation, and outpatient services, and many States use Medicaid waivers for managed care programs targeted at substance abuse treatment.^{1, 2} Medicaid reimburses health care providers for treatment given to eligible low-income individuals and families who cannot pay their medical expenses.³

Sources of payment, including Medicaid, for substance abuse treatment can be monitored using data from the Treatment Episode Data Set (TEDS), an annual compilation of data on the demographic characteristics and substance abuse problems of those admitted to substance abuse treatment, primarily at facilities that receive some public funding. TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once during a single year.⁴

TEDS includes a Minimum Data Set collected by all States and jurisdictions and a Supplemental Data Set collected by some States and jurisdictions. Expected/actual primary source of payment is a Supplemental Data Set item that identifies the primary source of payment for a treatment episode.⁵ This report is based on data from the 27 States or jurisdictions with a response rate of 75 percent or higher on this data element in 2005.⁶

This report compares the characteristics of admissions with Medicaid as the primary expected or actual source of payment (referred to in this report as "Medicaid-paid") with those of all other admissions with a known primary expected or actual source of payment.

In 2005, there were almost 614,300 substance abuse treatment admissions with known primary source of payment in the States with sufficient data for analysis. Nearly 81,100 of these admissions (13 percent) reported Medicaid as their primary expected or actual source of payment. Other sources of payment included other government payments⁷ (35 percent), self-pay (23 percent), no charge (free, charity, special research, or teaching) (12 percent), Blue Cross/Blue Shield (2 percent), other health insurance companies (4 percent), Medicare (1 percent), worker’s compensation (less than 1 percent), or other unspecified sources (10 percent).

Compared to admissions paid by other sources, higher proportions of Medicaid-paid substance abuse treatment admissions in 2005 were young, female, and/or Black. Medicaid-paid admissions were more likely than other admissions to be younger than 18 years old (21 vs. 7 percent) (Figure 1) and more likely to be female (52 vs. 30 percent). Medicaid-paid admissions were also more likely than those paid by other sources to be Black (26 vs. 19 percent) and less likely to be Hispanic (5 vs. 11 percent) (Figure 2).

Figure 1. Treatment Admissions, by Source of Payment and Age Group: 2005

Figure 2. Treatment Admissions, by Source of Payment and Race/Ethnicity: 2005

Medicaid-paid admissions aged 18 and older were more likely than other admissions in that age group to be "not in the labor force" (42 vs. 26 percent) and less likely to be employed full time (8 vs. 28 percent). However, Medicaid-paid and other admissions showed less difference in their proportions of admissions that were unemployed (44 vs. 38 percent) or employed part time (6 vs. 8 percent).⁸

The majority of both Medicaid-paid admissions and other admissions reported alcohol or marijuana as the primary substance of abuse in 2005.⁹ However, Medicaid-paid admissions were less likely than other admissions to report alcohol as the primary substance of abuse (28 vs. 42 percent) and more likely to report marijuana (26 vs. 17 percent) (Figure 3).

Figure 3. Treatment Admissions, by Source of Payment and Primary Substance of Abuse: 2005

In 2005, admissions primarily paid or expected to be paid by Medicaid were less likely than admissions paid by other sources to be referred by the criminal justice system (29 vs. 39 percent) and more likely to be referred to substance abuse treatment by community providers (18 vs. 13 percent) (Figure 4).

Figure 4. Treatment Admissions, by Source of Payment and Source of Referral: 2005

The type of substance abuse treatment service to which clients were admitted differed by source of payment.¹⁰ In 2005, Medicaid-paid admissions were less likely than those paid by other sources to receive detoxification treatment services (9 vs. 24 percent), more likely to receive ambulatory treatment services (77 vs. 60 percent), and about as likely to receive rehabilitation/residential treatment services (14 vs. 16 percent).

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.    Site Map | Contact Us | Accessibility | Privacy Policy | Freedom of Information Act  Disclaimer | Department of Health and Human Services | SAMHSA | White House | USA.gov * PDF formatted files require that Adobe Acrobat Reader® program is installed on your computer. Click here to download this FREE software now from Adobe. What's New Highlights Topics Data Drugs Pubs Short Reports Treatment Help Mail OAS