Telephone Care Management of Medicaid recipients with depression: A Randomized Control Trial

Telephone care management(TCM) has been shown to improve outcomes for depressed patients. However, there is a lack of studies on its effectiveness for Medicaid recipients. This study examines a one-year TCM intervention designed to help low-income individuals experiencing major depression to enter and remain in in-person treatment. This study included 499 Medicaid participants who screened positive for depression in Rhode Island at baseline (average age of 35(18-64yo) and 90% were women). After random assignment, the intervention group received intensive monitoring from care managers to facilitate clinical treatment. The control group received usual care, which included referrals to mental health treatment providers. Depression severity was measured at baseline, six and 18 months. Administrative and survey data provided information on utilization of mental health services. Qualitative data were drawn from care managers' case notes. At 18 months follow-up, the mean depression scores between the program and control groups were not significantly different. Although care managers were able to contact 91 percent of those assigned to the program group and averaged about 9 contacts per client over a year, less than a third of the participants received in-person professional treatment specifically for depression. The participants typically faced a proliferation of ongoing stressors in multiple life domains. The cumulative impact of these life stressors greatly limited or overwhelmed clients' efforts to seek or maintain in-person care. The lack of success among Medicaid recipients highlights the need for a more intensive intervention that may require more than a telephonic care management.