Utilizing Massachusetts Medicaid data to inform health service utilization, expenditures, and prevalence of comorbid conditions for people with intellectual disabilities

Information on health service utilization, insurance coverage, and health status of people with intellectual disabilities (ID) is limited and incomplete. Existing evidence suggests per capita health care expenditures for people with ID served by Medicare and Medicaid are at least $50,000 and at minimum 5 times higher than for people without ID. The absence of complete information for this population is a critical gap in the literature and hinders the ability to target and track the progress of public health initiatives for this high utilizing group.

In an effort to address this issue, Massachusetts is one of five pilot states working with the Association of University Centers on Disabilities and the Center for Disease Control and Prevention on a pilot project to identify people with ID using Medicaid data. The purpose of the pilot project is to test the performance of an algorithm to identify people with ID, and to analyze patterns of health service utilization, cost of care and prevalence of comorbid chronic conditions. 

Experiences with the algorithm in Massachusetts Medicaid data will be discussed, as well as state-specific findings of the demographics, prevalence of chronic health conditions and service utilization and expenditures for this population. Findings will be compared with what is known from other sources about the demographics of state-service recipients in order to inform validity of methods.  Findings from Massachusetts’ experience will likely have relevance for other states with similar expanded Medicaid coverage under the Affordable Care Act, and similar Medicaid data structure.