Impact of Medicaid cutbacks on people with schizophrenia who use atypical antipsychotic medication

People with schizophrenia often depend on Medicaid to finance mental health services as well as antipsychotic medication. Studies conducted in the 1980's and early 1990's suggested that reductions in pharmaceutical coverage and-or Medicaid enrollment, respectively, could result in unfortunate consequences (such as increased hospitalization) for clients with schizophrenia. The present project examined impact of Medicaid cutbacks on Oregon clients with schizophrenia who had (before retrenchment) been prescribed atypical (second generation) antipsychotic medication. Using numerous mechanisms such as eligibility restrictions, premiums, co-payments, and lockouts, Oregon authorities reduced Medicaid enrollment dramatically during 2003. The project focuses on Oregon Medicaid clients with diagnosis of schizophrenia who received at least one dispensing of clozapine, olanzapine, risperidone, ziprasidone, or quetiapine during the baseline calendar year 2002 (prior to Medicaid cutbacks). There are three cohorts comprising those who lost Medicaid coverage in calendar year 2003 (N = 472), those who lost Medicaid coverage in 2004 (N = 213), and those who maintained Medicaid coverage throughout the study years 2002, 2003, and 2004 (N = 3713). Subjects were on average 45 years old, 45% female, and 90% white. Analyses controlling for age, gender, race/ethnicity, Medicaid eligibility, and Medicare coverage showed those who maintained Medicaid coverage had little change in hospitalization whereas hospitalization increased markedly over time for subjects who lost Medicaid coverage (p less than 0.01). This finding was due almost entirely to increased state mental hospitalizations with little change found for admissions to general hospital psychiatric units. Loss of Medicaid coverage generally preceded hospitalization.