TBI prevalence, service utilization and costs among Medicaid beneficiaries in Michigan

Medicaid data have the potential to provide critical information on the prevalence, characteristics, service provision, and cost of care of patients with specific injuries or health conditions. This retrospective study first analyzed Michigan Medicaid data from FY2002-06 of patients with a TBI claim. All TBI and non-TBI claims for a subgroup of TBI hospitalized cases were further analyzed to determine the TBI-related services and costs over time.

From FY2002-06, a total of 129,153 Medicaid enrollees in Michigan received TBI-related services. Only 12% had a TBI-related hospitalization while most incurred services in emergency departments or outpatient settings. Males predominated among the more severe TBI cases, while both sexes were almost equally represented in the non-hospitalized population. Among the less severe cases, 51% were children under 15. 43% of hospitalized cases had diagnoses indicating skull fracture, laceration/contusion of the brain, and/or brain hemorrhage. Over 90% of strictly ED cases had diagnoses of unspecified head injury, unspecified brain injury, and/or concussion; and 50% underwent a CT scan. Medicaid FFS paid out $19.8 million annually for TBI-related services, of which 90% were incurred by more severe cases. Longitudinal analysis of hospitalized cases showed a high number of re-hospitalizations (49%) and ED visits (58%) within two years following the initial TBI-related hospitalization.

Cost estimations presented in the study are based only on the FFS claims since the MHP contracts are capitated and therefore bills are not submitted for each service. The actual cost of TBI to Medicaid is certainly much higher.