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In May 2017, the Missouri General Assembly expanded the Medicaid Managed Care Organization (MCO) service area from 54 counties in the middle of the state to the entire state. As a result, approximately 160,000 children were shifted to Medicaid MCO coverage. Among them were 2,152 children and adolescents ages 5 to 19 who were hospitalized for psychiatric reasons with Medicaid fee-for-service coverage before, and Medicaid MCO coverage after, May 1, 2017.
These children and adolescents formed a distinct cohort to study how a change of insurance coverage might affect hospital length of stay and subsequent rehospitalization. Suicidality rates for children and adolescents within 30, 60 and 90 days of discharge from a Missouri psychiatric hospital were evaluated using hospital claims data between Oct. 1, 2015, and June 30, 2018.
After the expansion, the rates of rehospitalization for suicidal behavior roughly doubled for all three postdischarge periods studied: The 30-day postdischarge rate jumped from 5.3% to 9.7%; the 60-day rate increased from 7.8% to 15%; and the 90-day suicidality rate rose from 10.4 % to 18.8%.
Mental health professionals in the state said that the data substantiated a problem that had been apparent to them well before the expansion: MCOs are authorizing hospital days children for children based on criteria that reflect resolution of only the most acute symptoms.
“The proprietary tools used by managed care organizations [for determining authorization of hospital days] consider only current symptom severity and risk to self or others,” said psychiatrist Joe Parks, M.D., medical director of the National Council for Behavioral Health and former director of Medicaid in Missouri.
For in-depth coverage of the MHA report see the Psychiatric News article, “Missouri Report Finds Rise in Readmission for Suicidal Behavior in Teens on Medicaid.”
(image: iStock/belterz)
