Ethnic disparities in treated prevalence of mental health disorders in six Medicaid programs

Background. Medicaid covers over 20 million consumers of mental health services in the US, however, little is known about ethnic differences in treated prevalence of mental health disorders among Medicaid beneficiaries. Objective. To test for ethnic differences in 12-month treated prevalence of mental health disorders overall and by treatment setting: community-based, inpatient, emergency room and outpatient hospital. Methods. Medicaid claims data from six states. The effect of ethnicity was estimated adjusting for personal characteristics, health status, disability, and several county level resource and local economy variables. All estimates were assessed in view of consistency across states. Findings. Hispanics and African American beneficiaries had lower overall treated prevalence of mental illness which in turn was driven by lower odds of treatment in community-based settings. These differences were large (OR often at or below 0.5) and persisted across states. There were no consistent differences in mental treatment in inpatient, emergency room or outpatient hospital settings. Conclusions. In light of population estimates of prevalence of mental illness, this study points to inadequate mental health treatment among all Medicaid beneficiaries (less than 9%) which affects disproportionately African Americans and Hispanics. Consistent findings across diverse Medicaid programs lend credibility to the claim of disparities in community mental health treatment and have implications for where ethnic disparities are targeted, and on what level - federal versus state. The lack of consistent disparities in inpatient and emergency care raises questions about the validity of findings of such disparities in previous studies.