Medicaid Managed Care & Access to Alcohol Treatment

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DESCRIPTION (provided by applicant): This project has been completely re-designed to have both descriptive and analytical components addressing treatment utilization by Medicaid clients with alcohol problems. This topic remains significant since Medicaid has undergone substantial change in the last decade as states have replaced fee for service programs with managed care systems such as capitation. Early studies in individual states indicate that these changes may have had considerable impact on Medicaid clients' use of alcohol and drug abuse treatment services. However, there are no published national studies pertaining to these issues. The project will make use of information contained in the Treatment Episode Data Set, Medicaid Eligibility file, Uniform Facility Data System, the Substance and Mental Health Services Administration's Managed Care Tracking System, the National Association of State Alcohol and Drug Abuse Directors annual surveys, and other national data sets. The national data will be combined so as to obtain information on a state by state and year by year basis. Tables and graphs will be produced describing changes in state substance abuse treatment policies for and use of services by Medicaid clients with alcohol problems. In the analytic phase of the project the researchers will generate statistical models of access to alcohol and drug abuse treatment services by Medicaid clients that adjust for state by state and year by year variation in Medicaid enrollment, treatment program availability, and prevalence of alcohol problems in the Medicaid population, among other covariates. Hypotheses pertaining to changes over time in service use, client severity, and treatment modality will be tested. The investigators will explore application of hierarchical models and latent variable growth curves to the national data sets. The results will be of considerable interest to state Medicaid and alcohol drug abuse program directors.