Adult Medicaid Beneficiaries Research Articles

Rural–urban differences in dental opioid prescribing among adolescent/young adult and adult Medicaid beneficiaries

Rural–urban differences in dental opioid prescribing among adolescent/young adult and adult Medicaid beneficiaries

30-Month Impact of Medications for Opioid Use Disorder on Acute Care Utilization in Rural Communities.

To assess both the short- and longer-term impact of offering medications for opioid use disorder (MOUD, ie, methadone, buprenorphine, or naltrexone) on rates of all-cause emergency department (ED) visits and acute inpatient admissions (IP) over a 30-month period among Medicaid enrollees with opioid use disorder (OUD) residing in rural communities. A quasi-experimental retrospective analysis of longitudinal Medicaid claims data among continuously enrolled adult patients with OUD residing in 71 predominantly rural counties in the United States between 2018 and 2020. A cohort of patients receiving MOUD treatment was compared against a contemporaneous propensity score-matched comparison group consisting of those who received no MOUD during the period. The sample included 5370 patients with OUD in each group. At the index period (ie, the month in which any MOUD was used for the first time), buprenorphine was the most commonly used MOUD (82% of the MOUD treatment group). By the eighth month since the index period, MOUD use dropped below 60% among the MOUD treatment group. Over the 30-month post-MOUD period, MOUD treatment was associated with 24% (112 vs 148 per 1000 per month) and 52% (21 vs 44) lower rates of ED visit and IP admission rates, respectively (P < 0.001), relative to the comparison group. Moreover, the reductions persisted well after the 18th month period. Receipt of MOUD was associated with both immediate- and long-term lower rates in acute care utilization rates among adult Medicaid beneficiaries with OUD residing in rural communities despite significant treatment discontinuation.

Neighborhood Socioeconomic Disadvantage and Acute Care Utilization in Washington State Medicaid: A Retrospective Cohort Study.

Neighborhood disadvantage has been associated with potentially preventable acute care utilization among Medicare beneficiaries, but this association has not been studied in a Medicaid population, which is important for informing more equitable care and policies for this population. To describe the association between Area Deprivation Index (ADI) and acute care utilization (including potentially preventable utilization) among Medicaid beneficiaries in Washington State. Retrospective cohort study of 100% Medicaid claims. Mixed effects logistic regression was applied to estimate the association between state-level ADI decile and acute care utilization, adjusting for age, sex, self-identified race and ethnicity, Charlson Comorbidity Index, primary spoken language, individual Federal Poverty Level, homelessness, and rurality. Standard errors were clustered at the Census block group level. 1.5 million unique adult Medicaid beneficiaries enrolled for at least 11months of a calendar year during the period 2017-2021. Binary measures denoting receipt of ED visits, low-acuity ED visits, hospitalizations in a calendar year. Increasing levels of neighborhood socioeconomic disadvantage (by ADI decile) were associated with greater odds of any ED visits (adjusted odds ratio (aOR) 1.07, 95% confidence interval (CI) 1.06-1.07), low-acuity ED visits (aOR 1.08, CI 1.08-1.08), and any hospitalizations (aOR 1.02, CI 1.02-1.02). Among Medicaid beneficiaries, greater neighborhood socioeconomic disadvantage was associated with increased acute care utilization, including potentially preventable utilization. These findings signal potential barriers to outpatient care access that could be amenable to future intervention by health systems and payers.

Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries.

We identify the association between high- and low-intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients. Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California's San Francisco Bay Area. Due to the endogeneity of high-intensity services assigned to high-risk patients, we instrument for service intensity using the number of specialist case managers hired each month of enrollment. Zero-inflated negative binomial models with 2-stage residual inclusion estimated total and avoidable hospital admissions and ED visits 12 months post-enrollment for adult Medicaid beneficiaries enrolled between August 2017 and December 2018 (n = 19,782). Compared with low-intensity case management, high-intensity services were associated with a reduction in the incidence rates of inpatient admissions [incidence rate ratio (IRR) = 0.341, 95% CI: 0.106-1.102; P = 0.072], ED visits (IRR = 0.608, 95% CI: 0.188-1.965; P = 0.058), and avoidable ED visits (IRR = 0.579, 95% CI: 0.179-1.872; P = 0.091). No significant association was found between service intensity and the likelihood of an event being an excess zero. High-intensity social needs case management may be more effective than low-intensity service at reducing health care use for individuals with non-zero use, suggesting that intensive case management may be especially helpful in supporting discharge and transitions of care.

Effects of Medicaid managed care on early detection of cancer: Evidence from mandatory Medicaid managed care program in Pennsylvania.

To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania. We analyzed data from the Pennsylvania cancer registry (2010-2018) for adult Medicaid beneficiaries aged 21-64 newly diagnosed with a solid tumor. To ascertain Medicaid and managed care status around diagnosis, we linked the cancer registry to statewide hospital-based facility records collected by an independent state agency (Pennsylvania Health Care Cost Containment Council). We leveraged a natural experiment arising from county-level variation in mandatory MMC in Pennsylvania. Using a stacked difference-in-differences design, we compared changes in the probability of late-stage cancer diagnosis among those residing in counties that newly transitioned to mandatory managed care to contemporaneous changes among those in counties with mature MMC programs. N/A. Mandatory MMC was associated with a reduced probability of late-stage cancer diagnosis (-3.9 percentage points; 95% CI: -7.2, -0.5; p = 0.02), particularly for screening-amenable cancers (-5.5 percentage points; 95% CI: -10.4, -0.6; p = 0.03). We found no significant changes in late-stage diagnosis among non-screening amenable cancers. In Pennsylvania, the implementation of mandatory MMC for adult Medicaid beneficiaries was associated with earlier stage of diagnosis among newly diagnosed cancer patients with Medicaid, especially those diagnosed with screening-amenable cancers. Considering that over half of the sample was diagnosed with late-stage cancer even after the transition to mandatory MMC, Medicaid programs and managed care organizations should continue to carefully monitor receipt of cancer screening and design strategies to reduce barriers to guideline-concordant screening or diagnostic procedures.

Abstract A125: Effects of Medicaid managed care on cancer staging: Evidence from Pennsylvania's mandatory Medicaid managed care program

Abstract Introduction: Cancer contributes disproportionately to the disease burden among adult Medicaid beneficiaries, underscoring a need for early cancer detection to improve cancer outcomes. One policy development within Medicaid that may influence the timeliness of cancer detection is the use of managed care. Medicaid managed care (MMC) programs may promote early-stage diagnosis through their emphasis on care coordination, disease screening, and primary care management. However, little research has examined the impact of MMC and cancer staging. Therefore, we estimated the effects of implementing mandatory MMC on early vs. late-stage diagnosis among incident cancer cases insured by Medicaid in Pennsylvania. Methods: We included non-elderly adults aged 21 to 64 diagnosed with solid tumors in the Pennsylvania cancer registry (2010-2018). To ascertain insurance and MMC status, we linked the sample to their inpatient/outpatient hospital discharge records (containing payer information for the visit) within one month of diagnosis. We leveraged a natural experiment arising from county-level variation in the implementation of a mandatory MMC program in Pennsylvania. Using a stacked difference-in-differences (DD) design to account for staggered treatment timing, we analyzed changes in the stage of diagnosis among incident cancer cases in counties that newly transitioned to mandatory MMC in 2012/2013 (“treated”), before and after the transition. We compared changes in these treated counties to contemporaneous changes among counties that had mandatory MMC in operation since 1997 (“controls”). We estimated incident case-level linear probability DD models and controlled for patient demographics (age, sex, race/ethnicity, rurality, and area deprivation index), county-level healthcare resources (constructed using the Area Resources Files), and county- and year-quarter-by-stack fixed effects. Results: We found a significant reduction in late-stage diagnosis of 3.9 percentage-points, or pp (95% CI: -7.2, -0.5; P = .023; baseline mean: 55.9%) in the treated counties vs. control counties, before and after the transition. The effect of mandatory MMC were driven by a greater reduction in late-stage diagnosis in screening-amenable cancer cases (DD: -5.5 pp; 95% CI: -10.4, -0.6; P =.027), especially breast and cervical cancer cases (DD: -8.9, 95% CI; -16.8, -0.9, P = .029). Conclusions: Mandatory MMC was associated with a reduced probability of late-stage diagnosis, particularly for screening-amenable cancers, suggesting that care coordination and primary care management may contribute to early detection of cancer in Medicaid. However, late-stage diagnosis was still highly prevalent among Medicaid beneficiaries, both before and after the transition to mandatory MMC. Medicaid programs and managed care organizations should continue to carefully monitor cancer screening and design strategies to reduce barriers to screening. Citation Format: Youngmin Kwon, Howard B. Degenholtz, Bruce L. Jacobs, Eric T. Roberts, Lindsay M. Sabik. Effects of Medicaid managed care on cancer staging: Evidence from Pennsylvania's mandatory Medicaid managed care program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A125.

Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients.

Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain. Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019). We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk. These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.

Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis.

Adults with mental illnesses are more likely to have low income and diet-related chronic diseases. This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries. This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program. Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system. Food security was measured with the 10-item US Adult Food Security survey module (0= high food security, 1-2= marginal food security, 3-10= low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls. Multivariable regression analyses adjusted for demographics, income, and survey date. Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P= 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P= 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P= 0.99). In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.

Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic.

We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. NC Medicaid 2019-2021 beneficiary and claims data. This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.

Chronic Disease, Functional Limitations, and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19

ABSTRACT From 2018–2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51–64 years (n = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22–14.43) and lung disease (OR: 3.79; 95% CI: 2.10–6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions.

704-P: Effects of Comorbidity Burden among Adult Medicaid Beneficiaries with Type 2 Diabetes

Diabetes self-management and health outcomes are complicated by comorbid conditions. Obesity, arthritis, pain conditions and others can create barriers to exercise and blood sugar goals. The burden patients experience managing chronic conditions may affect subsequent behaviors and outlook, creating a negative cycle. Understanding the impact of patients’ perceptions of comorbidity burden may inform future patient-centered healthcare services and community supports. We conducted a secondary data analysis using baseline and 3 month follow up survey data from an ongoing social needs intervention trial involving adult Medicaid beneficiaries with Type 2 diabetes. The sample (N=350) was 24-68 years old (M=52, SD=9), mostly female (n = 274; 78%), African American (n = 232; 66%) or White (n = 98; 28%), and had a mean of 7.6 (SD=3.0) of the 21 conditions, including diabetes, assessed at baseline. Each condition was rated by participants for impact on their daily activities (1=not at all; 5=a lot). Sum scores reflect ratings for diabetes burden only (M=2.9, SD=1.6) and all other conditions combined (M=21.0, SD=12.7). Bivariate correlations showed significant (p&amp;lt;.05) positive associations between diabetes burden and three month outcomes: sum social needs (r= .17), stress (r= .11), depression (r= .14), diabetes distress (r= .35), frequency of checking blood sugar (r= .16), but inverse associations with difficulty sleeping (r= -.17) and diabetes self-efficacy (r= -.15). The associations with other comorbidity burden ratings were similar except stronger with depression (r= .33) and receipt of government assistance programs (r= .17). Although people with diabetes have substantial self-management responsibilities, the effect was not different from other comorbidity burden on social needs and psychosocial outcomes, suggesting that similar or holistic interventions to reduce the negative effects of disease burden may be more efficient and effective to implement than disease-focused interventions. Disclosure A.Mcqueen: None. N.Verdecias: None. C.A.Caburnay: None. R.E.Smith: None. D.J.Broussard, jr.: None. D.A.Von nordheim: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK115916-01)

705-P: Examining Psychosocial Correlates of HbA1c Testing Frequency

Evidence supports guidelines for quarterly HbA1c testing for optimum diabetes control. Understanding patient-level factors associated with testing frequency may inform future interventions. Previous research with insured patients found greater testing frequency was associated with older age, uncontrolled baseline HbA1c, and comorbidities. This secondary analysis used baseline survey data from an ongoing intervention trial with the first 383 adult Medicaid beneficiaries with type 2 diabetes to have 12 months of follow up and medical claims data. Participants had an HbA1c test date &amp;lt;4mo prior to enrollment and reported the value &amp;gt;7.0 or “don’t know”. Associations with ≤2 vs. 3+ test dates over 12 months and demographic, health, and psychosocial correlates were examined. Participants were female (77%), White (30%), Black (70%), age M=51.66 (SD=9.32), had M=2.90 social needs (SD=1.70), and including diabetes, had M=7.62 (SD=3.05) chronic conditions. Of 1,710 HbA1c claims; 119 were excluded for &amp;lt;30 days of a previous claim. Participants with 1-2 claims (N=110, 29%) were compared to those with 3+ claims (N=273, 71%). Greater testing frequency was associated (p&amp;lt;.05) with: less likelihood of having children at home, more likely to be on insulin, more likely to report an HbA1c &amp;gt;9.0 or “don’t know”, more compliant with diabetes medicine and glucose testing at home, poorer physical functioning and general health, less future time orientation, and more diabetes distress. Testing frequency was not associated with age, race, employment, disability, sum social needs, sum comorbidities, stress, depression, diabetes self-efficacy or social functioning. Only having children at home (OR=0.53; 95%CI 0.53-0.88) and future time orientation (OR=.50; 0.30-0.82) were significant in a multivariable model. Some participants with 3+ tests may be more engaged in better diabetes care due to fewer family demands. Others in better health with less diabetes distress may need messaging to increase the perceived need for quarterly testing. Disclosure A.Mcqueen: None. C.J.Herrick: Consultant; Teladoc Health, Other Relationship; Merck &amp; Co., Inc., Eli Lilly and Company. L.Li: None. R.E.Smith: None. N.Verdecias: None. D.J.Broussard, jr.: None. D.A.Von nordheim: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK115916-01)

Job loss negatively impacts the mental health of working Medicaid beneficiaries

PurposeFew have studied the relationship between employment and health in the Medicaid population. The purpose of this study is to estimate the impact of job loss on the mental health of working Medicaid beneficiaries.Design/methodology/approachThis study conducted a post hoc analysis of 1,538 adult Medicaid beneficiaries enrolled in a prospective cohort study. The authors matched participants who lost their job to participants who remained employed based on demographics, illness severity and social determinants of health. The authors estimated the effect of job loss on the odds of a diagnosis of depression and/or anxiety and self-reported mental health during a one-year follow-up period, stratified by prior history of depression and/or anxiety as documented in the Medicaid claims.FindingsAmong participants with no preexisting depression or anxiety, the incidence of depression or anxiety was 17% versus 7% (aOR = 2.85; 95% confidence interval (CI): 1.88 to 4.34) between those who lost versus kept their job, respectively, and the mean difference in self-reported mental health was −4.3 (95% CI: −6.02 to −2.58). Self-reported mental health was also poorer between those who lost versus kept their job among participants with preexisting depression and/or anxiety (x = −4.78 (95% CI: −8.90 to −0.66).Research limitations/implicationsLimitations of this study are as follows: we may not have matched on all factors that influence retaining a job; we do not distinguish between involuntary and voluntary job loss; generalizability is limited; and employment information is based on self-report.Practical implicationsOur society should invest more resources into supporting low-wage workers such as Medicaid beneficiaries.Social implicationsActive labor policies that connect people to jobs, help them retain their job and support skills training to secure a better quality job, could reduce health disparities in the Medicaid population.Originality/valueUse of both claims and self-reported mental health information to evaluate the impact of job loss on working Medicaid beneficiaries.

Social Needs Are Associated With Greater Anticipated Needs During an Emergency and Desire for Help in Emergency Preparedness Planning.

Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency. A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473). The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses. Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.

Social Determinants of Health Influence Future Health Care Costs in the Medicaid Cohort of the District of Columbia Study.

Social determinants of health are an important predictor of future health care costs but little is known about their impact on Medicaid spending. This study analyzes the role of social determinants of health (SDH) in predicting future health care costs for adult Medicaid beneficiaries with similar past morbidity burdens and past costs. We enrolled into a prospective cohort study 8,892 adult Medicaid beneficiaries who presented for treatment at an emergency department or clinic affiliated with two hospitals in Washington, DC, between September 2017 and December 31, 2018. We used SDH information measured at enrollment to categorize our participants into four social risk classes of increasing severity. We used Medicaid claims for a 2-year period; 12 months pre- and post-study enrollment to measure past and future morbidity burden according to the Adjusted Clinical Groups system. We also used the Medicaid claims data to characterize total annual Medicaid costs one year prior to and one year after study enrollment. The 8,892 participants were primarily female (66%) and Black (91%). For persons with similar past morbidity burdens and past costs (p < 0.01), the future morbidity burden was significantly higher in the upper two social risk classes (1.15 and 2.04, respectively) compared with the lowest one. Mean future health care spending was significantly higher in the upper social risk classes compared with the lowest one ($2,713, $11,010, and $17,710, respectively) and remained significantly higher for the two highest social risk classes ($1,426 and $3,581, respectively), given past morbidity burden and past costs (p < 0.01). When we controlled for future morbidity burden (measured concurrently with future costs), social risk class was no longer a significant predictor of future health care costs. SDH are statistically significant predictors of future morbidity burden and future costs controlling for past morbidity burden and past costs. Further research is needed to determine whether current payment systems adequately account for differences in the care needs of highly medically and socially complex patients.

Comparing Pre- to Post-COVID-19 Health Disparities Between Black and White Female Connecticut Medicaid Beneficiaries in Behavioral Health Utilization

Background Broad health disparities (HDs) persist in Connecticut and the United States between minority and White patients, especially in access to and the utilization of behavioral telehealth services. Objective We aimed to determine the geographic distribution of HDs in Connecticut between Black female and White female adults in Medicaid behavioral telehealth utilization in 2019 and 2020. Methods We used the following spatial Connecticut data: (1) behavioral health utilization from Medicaid claims, from the Connecticut Department of Social Services, for the third quarters of 2019 and 2020; (2) mental health and drug and alcohol treatment facilities and ZCTA (ZIP Code Tabulation Area)-level descriptors from PolicyMap; and (3) Connecticut ZIP-to-ZCTA crosswalk data. Data were joined spatially, merged, and analyzed using spatial autoregressive models in Stata 17 (with outcome, predictors, and errors spatial lags). We computed ZCTA-level HDs comparing Black and White adult female Medicaid beneficiaries’ rates of face-to-face and telehealth behavioral services utilization. Spatial regressions were used to test spatial effects, which are extensions of classic regressions, that add neighbors’ effects to covariates. Results Distances to nearest treatment facility vary quite widely in Connecticut by ZCTAs, from 0.06 mile to 13.4 miles—3.5 miles on average. The overall White female versus Black female HDs in behavioral health care utilization were impacted by the distance to the nearest facility, such that ZCTAs farther away from the nearest facility display larger Black versus White HDs—nearly statistically significant effect in 2019 and significant effect in 2020. In 2020, in ZCTAs situated farther away from treatment facilities, both White female and Black female Medicaid patients had higher telebehavioral health utilization (spatial effects +1.3% points and +2.0% points, respectively, for 1 more mile farther away). The differential Black versus White female HDs in telebehavioral health care utilization were not impacted by distance to nearest facility, according to the total effect (direct and indirect through neighboring ZCTAs; P=.26). Conclusions Quantitative analyses indicate broad differences in Medicaid enrollment and the utilization of behavioral health services among Black and White female Medicaid recipients in Connecticut and that these differences were rather stable between 2019 and 2020. It appears that the expansion of telebehavioral health services in 2020 enhanced the access to treatment among residents who were located furthest away from providing facilities. Conflicts of Interest None declared.

Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries : A Randomized Study.

Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074). Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. 57972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. Contra Costa Health Services via the Medicaid waiver program.

SA15 Real-World Calibration of the Disease Recovery Evaluation and Modification (DREAM) Randomized Controlled Trial (RCT) in Adult Medicaid Beneficiaries with Recent-Onset Schizophrenia

To determine whether reductions in psychiatric hospitalizations with early initiation of paliperidone palmitate (PP) versus oral antipsychotic (OAP) therapy observed in a DREaM post hoc analysis are reproducible in real-world patients with recent-onset schizophrenia.

National and regional description of healthcare measures among adult Medicaid beneficiaries with schizophrenia within the United States

Aims Provide the first national description across the US of variations in healthcare measures in 2018 among Medicaid beneficiaries with schizophrenia. Materials and methods Adult beneficiaries with ≥2 diagnoses for schizophrenia, and continuous enrollment with consistent geographical data in all of 2018 were identified from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) data for 45 of 50 states. Antipsychotic (AP) utilization rates, including long-acting injectable APs (LAIs), quality metrics, and all-cause healthcare resource utilization and costs for claims submitted to Medicaid were reported nationally and by state. Pearson correlation evaluated associations between LAI utilization and total healthcare costs at state and county levels. Results Across the US 688,437 patients with schizophrenia were identified. The AP utilization rate was 51% (state range: 24–77%), while the LAI utilization rate was 13% (range: 4–26%). The proportion of patients adherent to any AP was 56% (range: 19–73%). Within 30 days post-discharge from an inpatient admission, 22% (range: 8–58%) of patients had an outpatient visit, and 12% (range: 4–48%) had a readmission. The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19–82%) and 45% (range: 20–70%). Per-patient-per-year total healthcare costs averaged $32,920 (range: $717–$93,972). At the county level, a weak negative correlation was observed between LAI utilization and total healthcare costs. Limitations This study included Medicaid beneficiaries enrolled with pharmacy and medical benefits, including beneficiaries dually eligible for Medicare; results cannot be generalized to the overall schizophrenia population or those with other payer coverage. Conclusions In 2018, half of beneficiaries with schizophrenia did not submit any claims for APs to Medicaid, nearly half had an emergency room visit, and one-third had an inpatient admission. Moreover, healthcare measures varied considerably across states. These findings may indicate unmet treatment needs for Medicaid beneficiaries with schizophrenia.

611-P: Do Social Needs Impact Quality of Life among Adult Medicaid Beneficiaries with Type 2 Diabetes?

Treatment trials increasingly include quality of life (QoL) measures to compliment clinical outcomes. Most QoL studies focus on clinical correlates. The growing appreciation for social determinants of health warrant examining how they impact QoL. This analysis of a preliminary baseline sample of 296 Medicaid beneficiaries with type 2 diabetes from an ongoing intervention trial examined the influence of social needs on aggregate and subscale T-scores of the SF12v2 QoL measure individually and controlling for covariates. We assessed 12 social needs (e.g., food, housing, utilities) and receipt of 9 resources (e.g., food stamps, WIC) . Participants rated having 22 chronic conditions and their impact (when applicable) on daily activity (1=not at all; 5=a lot) . Participants were female (76.7%) , White (29.1%) , Black (65.9%) , age M=51.8 (SD=9.3) , had M=2.7 social needs (SD=1.7) and M=1.3 (SD=1.2) resources. Including diabetes, participants reported M=7.4 chronic conditions (SD=3.0) with moderate impact M=23.0 (SD=14.4) . Mean QoL T-scores were all below the norm (50) except vitality (M=51.9, SD=11.4) . Sum needs were associated with aggregate mental health (r= -.13, p=.032) and 3 of 4 subscales: vitality (r= .16, p=.007) , role emotional (r= -.18, p=.002) , and social functioning (r= -.23, &amp;lt;.001) . For physical health, social needs were only associated with the pain subscale (r= -.17, p=.004) . Although the influence of social needs remained statistically significant for some subscales when controlling for chronic conditions, needs were most consistently associated with social functioning even when controlling for comorbidity impact, age, race, sex, and resources. We found few strong associations between social needs and SF12 scores, which may be due in part to limitations in how QoL is defined and measured and the distal causal pathway between social needs and functioning. Future analyses will examine changes in QoL over time and differences by treatment group and social needs. Disclosure A.Mcqueen: None. D.Brown: None. N.Verdecias: None. M.Kreuter: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK115916-01)