Racial/ethnic disparities in health care expenditures of chronically ill Medicaid beneficiaries

Racial/ethnic disparities in health status may be alleviated by directing interventions towards chronically ill low-income populations. The purpose of this study is to determine if significant racial/ethnic disparities exist at baseline among fee-for-service Medicaid beneficiaries eligible for a disease management pilot demonstration program in California. Information on the magnitude and direction of significant baseline disparities may be useful in targeting interventions to reduce such disparities. Failure to understand the magnitude of baseline disparities could also bias findings regarding the effectiveness of disease management programs across different racial/ethnic groups.

Cross-sectional California Medicaid claims data from September 2006 through August 2007 were analyzed. We examined total Medicaid expenditures of Latino, African American, Asian and Pacific Islander (AAPI), Armenian, and other white populations. We then examined racial/ethnic differences using a pooled linear regression model with log-transformed expenditures and controlling for specific chronic condition, whether a comorbid condition was present, severity of disease, and other demographic and utilization covariates. In addition, we stratified the regression analyses by chronic condition to examine potential disparities within specific diseases.

California Medicaid enrollees ages 22 and older enrolled in fee-for-service care with one or more of the following six chronic illnesses: asthma, atherosclerotic disease syndrome (ADS), congestive heart failure (CHF), diabetes, coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD). Fee-for-service beneficiaries in aged, disabled, and blind aid codes who had full scope coverage without share of cost, who did not receive Medicare, and resided in two pilot counties were included.

The population was relatively evenly distributed among whites (25%), Armenians (21%), Latinos (19%), and African Americans (22%) with AAPIs constituting the smallest group (11%). Whites had the highest level of unadjusted total expenditures ($10,220), followed by African Americans ($8,921), Latinos ($7,504), Armenians ($7,364), and AAPIs ($5,986). Armenians and AAPIs had significantly higher expenditures and Latinos and African Americans had significantly lower expenditures than whites.

Our findings indicate significant racial/ethnic disparities among Medicaid fee-for-service beneficiaries, but no consistent patterns across chronic disease category emerged. Higher adjusted expenditures for certain disease may indicate shortcomings in management of chronic conditions among these groups. On the other hand, lower adjusted expenditures for specific diseases may indicate access barriers to appropriate services.