Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. A. Populations Excluded from the Study

04/09/2012

To maximize the number of states included in the study, we limited our analysis to adults who qualified for Medicaid on the basis of disability, because this population is often excluded from managed care programs into which other beneficiaries are required to enroll. In addition, we limited the analysis to community-dwelling disabled beneficiaries because of differences in the service delivery systems and thus state Medicaid policies affecting the institutionalized population.

The study excluded beneficiaries who qualified for only partial Medicaid benefits and beneficiaries with other sources of health insurance coverage (including those enrolled simultaneously in Medicare or private insurance). With much of such individuals’ service use not Medicaid-funded, the MAX data would present an incomplete picture of their conditions and treatments. As suggested by our expert panel, to ensure an adequate amount of data to evaluate service use, the analysis only included beneficiaries with at least 10 months of continuous enrollment in Medicaid.

Table A.1 summarizes the Medicaid populations to be excluded from the study due to the limitations of the MAX data.

TABLE A.1. Populations Excluded from Analysis

Data Issue

Populations Excluded from the Study

Populations Included in the Study

MAX data contain only Medicaid-funded services. Beneficiaries with Medicare (duals) and those over age 64.

Beneficiaries with private insurance.

Beneficiaries qualifying only for restricted or partial benefits.

 

Beneficiaries qualifying for full benefits with no other sources of health coverage.

Beneficiaries with at least ten continuous months of enrollment.

 

States vary in ability to report to CMS complete and reliable enrollment and claims data. Beneficiaries in states with known problems in reporting key variables in their 2007 data.  
HMO or BHO encounter data may be missing or unreliable. Children and adult beneficiaries qualifying for Medicaid due to family status; such populations are more likely to be enrolled in managed care.

Beneficiaries in states using HMOs or BHOs that do not report encounter data to CMS.

Beneficiaries in states using HMOs or BHOs whose reported encounter data have missing or unreliable data on key variables for the analysis.

 

Working-age adults who qualify for Medicaid due to disability.

Beneficiaries in states that use FFS or PCCM to deliver Medicaid services.

Beneficiaries in states that use HMOs and/or BHOs to deliver services to disabled adults and report reliable and complete encounter data to CMS.

 

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