1077 — The Relationship Between Medicaid Managed Care Enrollment and Veterans' Use of VHA Services

Hynes DM, VIReC; de Groot KA, VIReC; Weichle TW, VIReC; Kan D, VIReC; Joyce MM, VIReC;

Objectives:
Studies examining Medicaid Managed Care (MC) show mixed effects of MC on healthcare utilization. No studies to date have examined the impact of Medicaid MC on Veterans' healthcare use. We examined the relationship between Medicaid MC and Veterans' use of Veterans Health Administration (VHA) services.

Methods:
In a retrospective study design, we studied Veterans under age 65, who were enrolled in VHA and Medicaid during 2009. We divided Veterans into groups, based on whether they had any comprehensive, Primary Care Case Management (PCCM), and/or behavioral MC during the year. We examined predictors of VHA outpatient utilization in Medicaid enrolled months using a population-averaged generalized estimating equation negative binomial regression model. Key covariates included demographic, socioeconomic, and geographic factors.

Results:
We found 241,209 Veterans who met our study criteria. Of these, 117,273 Veterans (48.6%) were enrolled in a Medicaid MC plan at least one month during 2009. We found that 65.0% of those with MC and 69.8% of those without MC used VHA outpatient services in 2009. Mean number of events during 2009 was lower among MC enrollees compared to non-MC enrollees (33.1 events vs 39.3 events, respectively, p < 0.01). Results from the regression model showed that, compared to non-MC enrollees, MC enrollees used fewer VHA services (comprehensive or PCCM MC: IRR = 0.78, p < 0.01; behavioral MC: IRR = 0.95, p = 0.01; comprehensive or PCCM MC and behavioral MC: IRR = 0.83, p < 0.01). Individuals eligible for Medicaid due to disability used 35% more VHA services compared to non-disabled enrollees (IRR = 1.35, p < 0.01).

Implications:
Approximately half of Veterans dually enrolled in VHA and Medicaid were enrolled in Medicaid managed care at least one month. Although Medicaid MC enrollees used fewer services than non-MC enrollees, use of the VHA remained substantial indicating that the VHA continues to offer a safety net.

Impacts:
Veterans have had different options for healthcare coverage over the years and these options are increasing due to Medicaid expansion under Affordable Care Act and the new Veterans Choice Act. As managed care options continue to grow, there will likely be continued need for safety net health systems like the VHA to provide the full range of healthcare needs.