Quantitative component year one report: Medicaid enrollee characteristics, service utilization, costs, and access to care in AHCA areas 4 and 6

Publication Date: 1/1/1998

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Description:

The Florida Mental Health Institute is responsible for conducting the independent evaluation of the Florida Prepaid Medicaid Mental Health Plan Demonstration currently being implemented in the Florida Agency for Health Care Administration (AHCA) Area 6 (Tampa Bay area). There are several components[IZ2] to the evaluation designed to comprehensively assess system level effects of the demonstration as well as recipient/member level effects. The Quantitative Component of the evaluation is involved primarily with compiling, integrating and analyzing the administrative databases (e.g., claims, encounter and eligibility data sets) associated with running and managing the Medicaid mental health system in Florida.

Using primarily a cross-sectional design, the analyses conducted in this Quantitative Component provide data plotted over time to examine the impact of changes in the managed care landscape in both the demonstration Area (Area 6[IZ3] – Tampa Bay area), and the comparison Area (Area 4 – Jacksonville area). The information details changes in the systems level service use among Medicaid recipients over a period of three years, using enrollment and claims level data, from March 1, 1994 to February 28, 1997 (two years prior to implementation of the demonstration and one year following initial implementation). It is not anticipated that many changes in the service levels will be reflected in the data at this time. Changes are more like to be detected in the second and third years of implementation, which will be examined at a later date.

The original design of this study was to examine differences between the MediPass and HMO financing conditions in both Areas 4 and 6 among AFDC and SSI eligibles. However, since the initial conceptualization, two major changes have affected the design. First, we were asked to include an examination of the General Eligibility fee for service condition as well, given that there are a number of recipients (proportion unknown) in this category who will eventually enroll in either MediPass or an HMO. There are several caveats that are presented in Section 2.3 that addresses this issue further. Second, there were difficulties obtaining encounter data from some of the HMOs, and of the data that we did receive, much of it was unusable for the types of analyses necessary in this study. Because of this HMOs were not included in the utilization and cost analyses. These two changes altered our design, and ultimately the findings that we are able to provide to the State at this time.