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de Groot K, Kan D, Weichle TW, Joyce MM, Hynes DM. VIReC VA/CMS Data for Research Poster: The Relationship Between Medicaid Managed Care Enrollment and Veterans’ Use of VHA Services. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.
Research Objective: Studies examining Medicaid Managed Care (MC) show mixed effects of MC on health utilization, health access, and health outcomes. No studies to date have examined the impact of Medicaid MC on Veterans' healthcare use. We examined the relationship between Medicaid MC and US Veterans' use of Veterans Health Administration (VHA) services. Study Design: In a retrospective study design, we studied Veterans who were enrolled in VHA and Medicaid during 2009. We divided the Veterans into groups, based on whether or not they had any comprehensive, Primary Care Case Management (PCCM), or behavioral MC during the year. We obtained data on VHA outpatient utilization, including care in VHA facilities and care paid for by VHA but provided in the private sector (aka fee basis). We examined predictors of VHA outpatient utilization in Medicaid enrolled months using a population-averaged generalized estimating equation negative binomial regression model with autoregressive correlation structure of order 1. We are also exploring the impact of additional geographic factors and the relationship with VHA healthcare use. Population Studied: Analysis included Veterans under age 65 enrolled in VHA and Medicaid during 2009. Principal Findings: 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. MC enrollment varied by sex (47% of males; 59% of females), age (68% among 18-35 year olds; 39% among 55-64 year olds), disability status (36% of disabled; 73% of non-disabled), and concurrent Medicare enrollment (23% of Medicare enrollees; 65% of non-Medicare enrollees). We found that 64.8% of those with MC and 69.6% of those without MC used services in VHA facilities. Mean service use at VHA facilities during the year was lower among MC enrollees compared to non-MC enrollees (28.8 events vs 33.1 events, respectively). Use patterns were similar for fee basis care. Medicine, diagnostic services, surgery, and psychiatry were the types of care with the largest number of events for both MC and non-MC enrollees. 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). Conclusion: 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 for those in need. Implications: Understanding how health insurance coverage influences healthcare use is critical in planning for population healthcare needs. 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 be encouraged in public and private health plans, there will likely be continued need for safety net health systems like the VHA to provide the full range of healthcare needs.