3173 — Use of VA Outpatient Services for Veterans with Behavioral Health Conditions after Enrolling in Medicaid

Vanneman ME, VA Palo Alto; Dally SK, VA Palo Alto; Phibbs CS, VA Palo Alto; Trivedi AN, Providence VAMC; Yoon J, VA Palo Alto;

Objectives:
Limited research has been conducted concerning dual enrollees in VA and Medicaid. Given a high prevalence of behavioral health conditions (BHC) in Veterans, we compared outpatient utilization for Veterans with and without BHC the year before and year after enrolling in Medicaid.

Methods:
Our cohort consisted of nonelderly VA enrollees without Medicare coverage who acquired Medicaid between CY2006-2009 in 32 states. We examined utilization of outpatient visits provided by VA and Medicaid for Veterans with and without BHC. We ran Poisson regression models to estimate counts of VA and Medicaid outpatient visits in the year after Medicaid enrollment, controlling for patient factors and state. We examined the association of BHC and utilization for: alcohol dependence, drug dependence, depression, tobacco/nicotine dependence, and serious mental illness (SMI).

Results:
In our cohort of 22,358 veterans, 41% had at least one BHC. On average, dual enrollees with BHC had a large number of VA outpatient visits (37; SD = 48) the year before enrolling in Medicaid that did not decrease (37; SD = 52) after enrolling in Medicaid. Yet, Veterans without BHC increased their utilization of VA outpatient services, from approximately 10 (SD = 12) to 14 visits (SD = 24) after enrolling in Medicaid. Additionally, Veterans with BHC used 0.6 more Medicaid outpatient visits than Veterans without BHC after enrolling in Medicaid. In the model predicting VA utilization, Veterans with drug dependence (IRR = 1.76) and SMI (IRR = 1.58) were especially likely to use more visits than Veterans without those respective conditions (both p < 0.001). In the model predicting Medicaid utilization, Veterans with drug dependence (IRR = 1.32) were particularly more likely to use more visits than Veterans without that condition (p < 0.001).

Implications:
Veterans with BHC used considerably more VA outpatient services than those without BHC. Furthermore, once dually enrolled in VA and Medicaid, Veterans with certain BHC, especially drug dependence, used significantly more outpatient services from both Medicaid and VA providers than Veterans without BHC.

Impacts:
Integrating behavioral and physical health in both VA and Medicaid could prove beneficial in addressing the healthcare needs of Veterans with BHC. Enhanced coordination between the two healthcare systems may optimize care for Medicaid-enrolled Veterans with BHC.