In 2017, the Missouri legislature expanded Medicaid managed-care organizations, or MCOs, state-wide, putting third-party contractors in charge of hundreds of thousands of patients. Advocates say managed care programs allow for more personalized care for patients and more predictable budgeting. But hospitals have criticized MCOs, saying they cover less and take longer to reimburse for care than traditional Medicaid.
Now, a new study from the Missouri Hospital Association suggests switching from traditional Medicaid to MCOs could be linked to increased risk of suicide in teens. Mat Reidhead is the Hospital Association's lead researcher.
In your study, you looked at a group of people, mainly children, who were switched from traditional Medicaid to these MCO programs - what were some of the differences in terms of care that you found?
Sure so what sort of lead up to the study was, first in 2016 we conducted a different piece of analysis and we found that rates of suicidality for children across Missouri had increased 900 percent in terms of the number that were going to hospitals for either contemplating or attempting suicide so 900 percent is a dramatic increase over that time. For years we've just been hearing these concerns stated by our psychiatric hospitals on care authorization practices used by the Medicaid managed care companies. They approve much less time to treat and stabilize children during in-patient care, they deny more than a quarter of the admissions, they refuse to pay for about 11 percent of the in-patient days once the child is admitted. And then they require approval from physicians that are employed by the health plans at virtually every turn. So these policies really set up the risk for severe unintended consequences for the kids with medicaid managed care, and whose care the state has paid these three MCOs to manage. So what we wanted to evaluate is how often children in Missouri were hospitalized for a mental health crisis and then had to return to a hospital or an E.R. within 30, 60 or 90 days for contemplating or attempting suicide. And we found that Medicaid fee for service had the lowest observed rates in each of those defined intervals of time following discharge from an in-patient psychiatric hospital. We took it a step further and we identified a treatment group of patients, so those were the beneficiaries that were actually affected by the MCO expansion policy after May 1, 2017 and we drew the same comparisons to our control group, which was our exact same children only before the policy was enacted, when they had fee for service coverage. And after they moved to managed care these kids, the exact same kids, had an average length of stay that fell by 16 percent and sucidality rates that nearly doubled across the board depending on, regardless of whether we were looking at 30, 60 or 90 days.
So basically, children who were covered by MCO plans spent a lot less time in-patient, and also had increased suicidality or suicide risk.
Are there changes that could be made as far as trying to get MCOs to cover longer in-patient care?
Sure, and we lay out several options and opportunities at the federal level, but we feel like we need to sit down with all of the stake-holders at the same table and come up with a way to standardize treatment and care for these children to ensure that they have the best possible outcomes in terms of their health and well-being.