This study found that significant variation across states in both the rates of mental illness among nursing home admissions and estimated rates of admission among people with mental illness.  The study also found that newly admitted individuals with mental illness were younger and more likely to become long-stay residents than non-mentally ill individuals.  The authors suggest that state-level mental health and nursing home factors may influence the likelihood of long-term nursing home use for people with mental illnesses.

Grabowski, D. C., K. A. Aschbrenner, et al. (2009). Mental illness in nursing homes: variations across States. Health Affairs, 28(3), 689-700. DOI: 10.1377/hlthaff.28.3.689 http://content.healthaffairs.org/cgi/content/abstract/28/3/689

Authors: David C. Grabowski, Kelly A. Aschbrenner, Zhanlian Feng, Vincent Mor.

This study examines M/SU parity laws and their potential effect on out-of-pocket mental health treatment costs.  The study found modest yet important variation in out-of-pocket burden across states but note that prescription drugs account for nearly two-thirds of out-of-pocket spending and fall largely outside the scope of federal M/SU parity laws.  The authors conclude that M/SU parity laws will do little to reduce the observed burden or inter-state variation.  

Zuvekas, S. H., & Meyerhoefer, C. D. (2009). State variations in the out-of-pocket spending burden for outpatient mental health treatment. Health Affairs, 28(3), 713-22. DOI: 10.1377/hlthaff.28.3.713 http://content.healthaffairs.org/cgi/content/abstract/28/3/713 

Authors: Samuel H. Zuvekas, Chad D. Meyerhoefer.

This study examined the effects of prior authorization for second-generation anti-psychotic and anti-convulsant on utilization, discontinuations in therapy, and pharmacy costs among Maine Medicaid beneficiaries with bipolar disorder.  The study found that the prior authorization policy resulted in an 8 percent the prevalence of use of non-preferred second generation drugs but did not increase the rate of use for preferred drugs or the rate of switching.  The policy reduced total pharmacy reimbursements for bipolar disorder by $27 per patient during the eight-month policy period but the hazard rate of treatment discontinuation was higher than during the pre-policy period.  The authors conclude that the use of prior authorization in Maine may have increased patient risk without significant cost savings to the Medicaid program. 

Zhang, Y., A. S. Adams, et al. (2009). Effects of prior authorization on medication discontinuation among Medicaid beneficiaries with bipolar disorder. Psychiatric Services, 60(4), 520-7.  DOI: 10.1176/appi.ps.60.4.520 http://psychservices.psychiatryonline.org/cgi/content/abstract/60/4/520 

Authors: Yuting Zhang, Alyce S. Adams, Dennis Ross-Degnan, Fang Zhang, Stephen B. Soumerai. 

This 2003 study examined states' compliance with their Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate that requires states to perform behavioral health screenings on all Medicaid-insured children.  The study found that 23 states had not addressed behavioral health screenings at all and that more states had screening tools for mental health than for substance abuse.  The study also recommends policy options for increasing behavioral health screening rates. 

The study is available from SAMHSA here: http://download.ncadi.samhsa.gov/ken/pdf/ManagedCare/736.pdf 

Citation: Semansky, R. M., Koyanagi, C., & Vandivort-Warren, R. (2003). Behavioral health screening policies in Medicaid programs nationwide. Psychiatric Services, 54(5), 736-739. 

Published in 2002, this report presents a set of 1995 Medicaid prescription psychoactive drug statistical tables for the non-elderly population, based on Medicaid data that States submit to the CMS. These statistics are presented in a uniform set of tables for each of 10 selected States, plus a set of tables that aggregates data across all 10 States. The tables provide a range of information on users, drug claims, and expenditures for each State. The fundamental purpose is to provide policy makers, interest groups, and others with basic information on prescription psychoactive drug use in Medicaid, and associated trends.

The tables are available from SAMHSA here: http://mentalhealth.samhsa.gov/publications/allpubs/SMA02-3712/default.asp

This report presents a basic set of Medicaid M/SU program statistics for the non-elderly population in a uniform set of tables for each of 10 selected States, plus a set of tables that aggregates data across all 10 States. Using daa from 1995, these tables provide a range of information on user characteristics, service utilization, and expenditures for each State. The fundamental purpose is to provide policy makers, interest groups, and others with basic information on M/SU services and expenditures in Medicaid, and associated trends.

The tables are available from SAMHSA here: http://mentalhealth.samhsa.gov/publications/allpubs/SMA02-3713/