Disparities in substance abuse initiation and engagement among non-elderly disabled Medicaid beneficiaries with Medicare dual eligibility: Access limited

Much is known about health service utilization and cost among non-elderly Medicaid beneficiaries who are dually-eligible for Medicare, yet little is known about this population's substance abuse (SA) treatment utilization. Medicaid pays for up to 20% of SA specialty treatment nationwide, while the Medicare program has very limited coverage for SA treatment. Using a cross-sectional design, research questions about SA treatment episodes were examined via analysis of national Medicaid administrative claims data from 1999. Using performance measures initially developed by the Washington Circle and further adapted by the National Committee on Quality Assurance for inclusion in HEDIS, a sample of non-elderly dually eligible beneficiaries (N=130,109) and a comparison group of non-dually eligible Medicaid beneficiaries (N=746,081) were identified. The sample was less likely to both initiate (age and gender-adjusted odds ratio (OR)= 0.9***, p<.001) and engage (age and gender-adjusted OR= 0.9***, p<.001) in SA treatment. Guided by Anderson's sociobehavioral model of health care utilization, predictors of initiation and engagement derived from multivariate logistic regression analysis are presented. Given that SA treatment initiation and engagement are predictive of treatment retention and better recovery outcomes, population-specific improvements in service provision are necessary. Implications relate to how existing social service and health systems provide SA-related care to beneficiaries with disabilities and areas in which improvements in access to and quality of SA treatment are needed.