nasmhpd resource management guide: impacts of affordable

Joel E. Miller, M.S. ED. Narges Maududi, B.S.

Florida

NASMHPD Resource Management Guide: Impacts of Affordable Care Act on

Coverage for Uninsured People with Behavioral Health Conditions

September 2013

About the Authors

Joel E. Miller, M.S. ED.

With over 30 years of experience in health care and mental health policy, Mr. Miller has

advocated for the creation of federal and state policy and regulatory solutions to expand

health insurance and mental health insurance coverage, and to improve the delivery,

quality and financing of health care and mental health care in the United States. In his

role as Senior Director of Policy and Health Care Reform at the National Association of

State Mental Health Program Directors (NASMHPD), he led the development and

implementation of NASMHPD’s policy agenda and legislative and regulatory strategies

designed to improve and support State Behavioral Health Agencies and state public

mental health systems.

Narges Maududi, B.S.

Currently serves as the Senior Administrative Assistant at the National Association of

State Mental Health Program Directors (NASMHPD), Office of Technical Assistance.

Ms. Maududi has over 10 years of experience in logistics and administrative

management.

Acknowledgements

The authors wish to thank Jobine Jacob and Aksheya Sridhar, who served as summer

interns at NASMHPD in 2013, for their contributions in creating key tables under the

Special Populations section of the guide.

The authors would also like to recognize Christy Lentz for her insight into the content

and final proofing of the document.

INTRODUCTION [1] APPENDIX A [7] APPENDIX B [8] RESOURCE MANAGEMENT MAP [9] SECTION I: 1. NATIONAL FINDINGS [10] SECTION II: 1. STATE FINDINGS ON COVERAGE [11]

A. SERIOUS MENTAL ILLNESS (SMI) [11] B. SERIOUS PSYCHOLOGICAL DISORDER (SPD) [14] C. SUBSTANCE USE DISORDER (SUD) [17]

2. ADDITIONAL STATE DATA [20]

SECTION III: 1. STATE FINDINGS FOR SPECIAL POPULATIONS [22]

A. UNINSURED CHILDREN WITH A SERIOUS EMOTIONAL DISTURBANCE [22]

B. UNINSURED VETERANS WITH A MENTAL ILLNESS [23]

SECTION IV: 1. DEMOGRAPHIC CHARACTERISTICS [24]

A. NATIONAL RATES [24] B. CHARACTERISTICS-SMI POPULATION [25] C. CHARACTERISTICS-SUD POPULATION [33] D. CHARACTERISTICS- UNINSURED PEOPLE 18-34 YEARS

OF AGE BY STATE [41]

SECTION V: 1. EXPECTED UTILIZATION RATE OF NEWLY INSURED POPULATIONS [42] 2. ILLUSTRATION OF USING DATA [44]

SECTION VI: 1. METHODS FOR ESTIMATING COUNTY–LEVEL BEHAVIORAL

H HEALTH SERVICE USE [45]

TABLE OF CONTENTS

INTRODUCTION

Background

Beginning in 2014 the Patient Protection and Affordable Care Act (ACA) extends

Medicaid coverage to all uninsured individuals aged 18 through 64 years of age with

incomes up to 133 percent of the federal poverty level (FPL), or $15,281 for an

individual and $31,320 for a family of four (based on the 2013 FPL). The eligibility for

the adult group also includes a 5 percent “income disregard” leading to an effective FPL

of 138 percent. Children are currently eligible and will remain eligible for either

Medicaid or the Children’s Health Insurance Program (CHIP) at higher income levels,

based on the eligibility standards already in effect in their state.

Although some individuals with employer-sponsored health insurance and individual

insurance may also obtain Medicaid coverage under the expansion, nearly every new

Medicaid eligible enrollee is currently uninsured.

The main focus of the estimates provided in this document is on the uninsured

population with mental health and substance use conditions which are highlighted

in the statistical figures and tables. The guide was developed by NASMHPD

primarily using new data released by the Substance Abuse and Mental Health

Services Administration (SAMHSA).

In one set of figures and tables embodied in the NASMHPD Resource Management

Guide, we provide national- and state-level estimates on the prevalence of mental health

and substance use conditions for the current adult Medicaid enrollees, and currently

uninsured adults with incomes that would make them eligible for new state Medicaid

expansions (i.e., < 139 percent of FPL).

In addition to extending Medicaid coverage, the Affordable Care Act will provide

subsidies for lower- and medium-income people who are uninsured between 139 percent

and 399 percent of FPL (some individuals also will be able to purchase coverage if their

incomes are between 100 and 138 percent of the FPL) to buy health insurance – as well

as apply penalties for individuals who fail to obtain health insurance. Those individuals

who receive subsidies – and others not eligible for subsidies – will be able to purchase

coverage through state health insurance exchanges (also called “online marketplaces) that

will provide access to information to potential consumers on a range of health insurance

programs and health plans.

These “State Affordable Insurance Exchanges” are targeted to those who are not enrolled

in Medicaid, Medicare, or affordable employer-based plans. As with the analysis of the

Medicaid expansion population, the following figures and tables focus on adults aged 18

to 64 years who are currently uninsured and have incomes that would make them eligible

for the subsidies (i.e., incomes between 139 percent and 399 percent of the FPL).

1

Sources of Data on Mental Illness and Substance Use

The National Survey on Drug Use and Health (NSDUH), sponsored by SAMHSA in the

U.S. Department of Health and Human Services is the primary source of information on

the use of illicit drugs, alcohol, and tobacco in the civilian, non-institutionalized

population of the United States aged 12 years or older. In recent years, it has also

included information on mental health conditions and use of mental health and substance

abuse services.

Data from NSDUH, the American Community Survey (ACS) – an ongoing statistical

survey sponsored by the U.S. Census Bureau – and additional SAMHSA data sets were

used to determine projections that included data from SAMHSA’s report on Behavioral

Health Treatment Needs for Assessment Toolkit for States. We also have noted other

documents and sources used in this report to augment the government surveys such as

those produced by The Urban Institute, which is a non-partisan, non-profit health care

policy research organization specializing in health insurance coverage issues. The data

in the figures and tables in the guide are primarily based on 2011 data, except where

noted.

Main Contents of the NASMHPD Resource Management Guide

The guide highlights the number and percentage of uninsured individuals with a mental

illness or substance use condition on a state-by-state basis using the following parameters

(Please see the NASMHPD Resource Management Map at the end of the Introduction):

1. Three Health Insurance Coverage Options Displayed By the:

Current Medicaid Program

New State Medicaid Expansion Program

New State Health Insurance Exchange (Marketplace) Program

The three coverage programs are embodied in several charts for comparison purposes.

2. Percentage and Number (Prevalence Projections) of Uninsured People Aged 18-

64, Eligible for Coverage under the Three Health Insurance Options Displayed

State-by-state by the Following Overall Conditions (See Appendix A to the

Introduction for a description of three overall categories):

Serious Mental Illness (SMI)

Serious Psychological Distress (SPD)

Substance Use Disorder (SUD)

2

The three overall conditions are embodied in several charts for comparison purposes.

3. Characteristics (Projected Percentages) of People with a Serious Mental Illness or

Substance Use Disorder (Serious Psychological Distress Data is Unavailable for

These Graphics) Eligible under the New Medicaid Expansion Program or Health

Insurance Exchange, Displayed State-by-State By the Following Designations:

Gender

Age (delineated by ages 18-34 and 35-64)

Race/Ethnicity

Education Level

4. Projected Utilization of Mental Health (Serious Mental Illness and Serious

Psychological Distress are combined) and Substance Use Treatments among

Adults Aged 18-64, Displayed State-by-State By the Following Health Insurance

Coverage Programs (Please see the formula in Appendix B at the conclusion of

the Introduction):

Eligible for Coverage Under the New State Medicaid Expansion Program

Eligible for Coverage Under the New State Health Insurance Exchanges

Projected Utilization is Broken Down By Each Health Insurance Coverage

Category By the Following General Treatments:

- Any Mental Health Treatment

- Any Inpatient or Outpatient Mental Health Treatment

- Any Substance Abuse Treatment

- Any Inpatient Mental Health Treatment

- Any Outpatient Mental Health Treatment

- Any Prescription Medication for Mental Health

- Any Specialty Substance Abuse Facility Treatment

NASMHPD Resource Management Guide Sections

Section I of the NASMHPD Resource Management Guide provides national projections

on the number of uninsured individuals with a mental health condition or substance use

disorder eligible for health insurance coverage under the Current Medicaid Program, the

New ACA Medicaid Expansion Program, and the New ACA State Health Insurance

Exchanges.

Section II describes the percentage and number of uninsured individuals aged 18-64

with either a serious mental illness, in serious psychological distress, or with a substance

use disorder, that are eligible for coverage under the Current Medicaid Program, the New

Medicaid Expansion Program or the New State Health Insurance Program for an

individual state (e.g., Connecticut) and state-by-state.

3

Section III spotlights data on two important special populations – children and veterans.

The section describes the percentage and number of uninsured children under the age

of 18 with a mental health condition who live in families with incomes below 200

percent of the federal poverty level state-by-state.

This section also contains data displayed by the number of uninsured veterans with a

mental illness with incomes below 138 percent, and between 139 percent and 399

percent of the FPL, making them eligible for coverage under the New Medicaid

Expansion Program and New State Health Insurance Exchanges, respectively displayed

state-by-state.

Section IV describes the characteristics (e.g., age) of people with a serious mental

illness or substance use disorder aged 18-64, that are eligible for coverage under the New

Medicaid Expansion Program or New Health Insurance Exchange displayed state-by-

state.

Section V provides projected utilization of mental health and substance use

treatment services (e.g., outpatient treatment) among adults aged 18-64 displayed

state-by-state by the following health insurance coverage programs: Eligible for

Coverage under the New Medicaid Expansion Program and Eligible for Coverage under

the New Health Insurance Exchanges.

Section VI provides information on how to use the data to determine the percentage and

number of uninsured individuals with mental health or substance use condition in an

individual county who are eligible for coverage under the New Medicaid Expansion

Program, and estimation of utilization of specific services.

There is a significant need for quantitative tools and data on which to base mental health

and substance abuse system planning. This is particularly true now, as the Affordable

Care Act provides insurance coverage for millions of currently uninsured Americans and

stimulates a myriad of new delivery system redesigns. The NASMHPD Resource

Management Guide provides several tools to assist state mental health agencies in

planning for the influx of newly insured people with mental health and substance use

disorders.

How State Behavioral Health Agencies and other Behavioral Health Professional

Organizations, Providers, and Advocates Can Use the NASMHPD Resource

Management Guide in Planning for the Implementation of the Affordable Care Act

The guide provides detailed information on the percentage and number of eligible people

who are uninsured with a mental health and substance use condition and projected

prevalence and use of services. These factors can be considered when deciding the

appropriate mix of mental health and substance use benefits, services, and providers to

meet the needs of newly eligible populations with a mental illness or substance use

disorder – as well as assisting in initial outreach and enrollment activities.

4

There are three broad aims (known as “The Triple Aim”) in which states are being asked

(as well as pressures by business groups and private sector payers) to focus on improving

the quality of health and mental health care:

Better Care: Improve the overall quality, by making mental health care and

health care more person-, family-, and community-centered, reliable, accessible,

and safe.

Healthy People/Healthy Communities: Improve the mental health of local and

state populations by supporting proven interventions to address mental, social,

cultural, and environmental determinants of positive mental health in addition to

delivering higher quality mental health care.

Affordable Care: Increase the value of mental health and health care for

individuals, families, employers, and governments.

Many individuals who will be newly insured and affected by new delivery mechanisms

innovations have lower incomes and may have significant unmet needs for mental health

and substance abuse treatment. Key decisions regarding the appropriate mix of services,

the adequacy of existing provider networks and workforce, licensing, quality

measurement, contracting, etc., must be informed by data to avoid unintended problems

with access, costs, and ultimately population health.

For example, new data embodied in this resource guide could be used by state

agencies to help:

Plan for targeted use of funds from state general revenues, the Mental Health

Block Grant and Substance Abuse Prevention and Treatment Block Grant;

Plan for service needs of newly eligible individuals;

Plan for development of adequate and sufficient networks of providers in

qualified health plans;

Plan for the Medicaid Benchmark plan;

Plan for outreach and enrollment assistance;

Assist the state in evaluating the impact that its outreach, eligibility

determination, enrollment, and re-enrollment systems will have on eligible

individuals with mental health conditions, and substance use disorders; and

Identify additional quality measures to be monitored.

Case Studies on the Use of Mental Health Care Needs Assessments

Maryland State Case Study: Using Data to Inform Planning

Maryland's experience with a primary care program for lower-income adults coupled

with thoughtful use of patient claims and authorization data have helped prepare the state

for a likely Medicaid expansion. Maryland has access to historical claims data that have

enabled the state to conduct analyses of costs and utilization by age group, diagnoses, and

eligibility criteria over time.

5

The state of Maryland used the data to generate projections and characteristics of the

population that will be newly Medicaid eligible in 2014. This information can be used in

developing cost estimates for the likely expansion and in preparing to meet the mental

health needs of the newly eligible population.

The data has also informed decisions in the Maryland Legislature. In 2013 Maryland

increased payment rates for Medicaid patients to match those of Medicare not only for

primary care providers, but for all physicians in an effort to incentivize behavioral health

service providers, including psychiatrists. Finally, the data has informed Maryland’s

decision to move forward in implementing tele-medicine statewide to accommodate the

needs of individuals in rural areas.

Maryland anticipates that enrollment of newly eligible individuals will be gradual. The

state will conduct targeted outreach efforts in jails, prisons, and state hospitals to increase

Medicaid enrollment as soon as possible upon release.

Maryland is hopeful that continuous data monitoring and provider incentives will equip

the state to deliver appropriate mental health services to newly covered low-income

adults.

Washington State Case Study: Using Data to Inform Planning

Washington has utilized data to help begin to assess and prepare for an expanded

Medicaid program in 2014. Washington’s integrated client database – which contains

mental health, Temporary Assistance for Needy Families (TANF), chemical dependency,

medical and child welfare, corrections, and jail utilization data – has been critical in

helping identify individuals at high risk and high need as part of the Medicaid expansion.

The data has also been critical in designing Washington’s health homes state plan’s

amendments. The state of Washington is also continuing to utilize data to inform

important budgetary decisions to ensure that the state is prepared to provide mental health

services to the newly eligible population. The current Medicaid managed care medical

contracts have outpatient visit limits (12 visits for adults and 20 visits for children);

however, to comply with mental health parity, visit limits will be removed for the newly

eligible Medicaid population in 2014.

Presently, the state is leaning toward eliminating visit limits for currently enrolled

Medicaid beneficiaries in order to have aligned benefit packages. The projected

enrollment and utilization estimates under expanded Medicaid program have identified an

increased need for mental health providers, particularly psychiatrists. In addition to

provider capacity for the newly eligible population, additional provider demand for the

currently eligible Medicaid population is likely. The state is currently working to

determine how to better incorporate mental health services into primary care. New data

can help inform allocation of resources at the state and county levels.

6

Appendix A to Introduction

Definitions of the Major Mental Health and Substance Use Conditions

Serious Mental Illness (SMI): Respondents to the National Survey of Drug Use and

Health (NSDUH) data meet the criteria for SMI in the past year if they have had a

diagnosable mental, behavioral, or emotional disorder (excluding developmental and

substance use disorders) of sufficient duration to meet diagnostic criteria specified within

the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

that has resulted in serious functional impairment that substantially interferes with or

limits one or more major life activities. Adult NSDUH respondents' mental illness is

determined based on modeling their responses to questions on distress (Kessler-6 [K6]

scale) and impairment (truncated version of the World Health Organization Disability

Assessment Schedule [WHODAS]). Conditions such as major depression, bipolar

disorder, and schizophrenia are included in this category.

Serious Psychological Distress (SPD): Respondents to the NSDUH are determined to

have SPD if they have a score of 13 or higher on the Kessler-6 (K6) scale. The Kessler-6

(K6) scale consists of six questions that gather information on how frequently adult

respondents experienced symptoms of psychological distress during the past month or

during the one month in the past year when they were at their worst emotionally. These

questions ask about the frequency of feeling (1) nervous, (2) hopeless, (3) restless or

fidgety, (4) sad or depressed, (5) that everything was an effort, and (6) no good or

worthless. Conditions such as panic and anxiety disorders are included in this category.

Substance Use Disorder (SUD): An adult is defined as having a SUD if they meet the

criteria for abuse or dependence for illicit drugs or alcohol. Abuse of illicit drugs or

alcohol is defined as meeting one or more of the four criteria for abuse included in the

DSM-IV. Dependence on illicit drugs or alcohol is defined as meeting three out of seven

dependence criteria (for substances that included questions to measure a withdrawal

criterion) or three out of six dependence criteria (for substances that did not include

withdrawal questions) for that substance, based on criteria included in DSM-IV.

Additional criteria for alcohol and marijuana dependence since 2000 included the use of

these substances on 6 or more days in the past 12 months.

7

Appendix B to Introduction

The Effect of Insurance Coverage on Utilization Rates:

Method for Determining Projected Increases in Utilization Rates

In projecting utilization rates under a new program, states must be aware that current

mental health and substance use rates may change once a population gains insurance

coverage.

A large body of research finds that once people move from being uninsured to insured,

they use more medical care and incur higher medical care costs. The extent of the

increase is often called elasticity of demand or an induction factor. Estimating the exact

amount by which use will increase once people become insured is equal parts “art” and

“science.”

A reasonable baseline estimate, which has been cited by Centers for Medicare and

Medicaid Services (CMS) in their recent regulatory impact analysis, comes from the

expansion of Oregon’s Medicaid program. In 2008 Oregon conducted a lottery to expand

access to uninsured adults with incomes below 100 percent of FPL. Approximately

10,000 randomly selected lower-income adults were newly enrolled in Medicaid. The

evaluation is particularly strong because it was able to compare outcomes for those who

won the lottery with outcomes for those who applied but were not selected, and it

contains an estimate of the benefits or outcomes of obtaining Medicaid coverage.

Evaluators of the Oregon data found that Medicaid coverage increases the probability of

using outpatient care by 35 percent, of using prescription drugs by 15 percent, and of

hospital admissions by 30 percent. Overall, they estimate that the increased health care

use from enrollment in Medicaid translates into about a 25-percent increase in total

annual health care expenditures. Although these estimates are useful as baseline

assumptions, utilization rates for particular mental health services and providers may

differ from the overall medical care utilization rates, and the rates will be influenced by

the types of insurance benefits offered.

The Oregon experience helped to inform the projections in Section V of the Guide.

8

1. Health Insurance Coverage Programs

• Current Medicaid Program

• New State Medicaid Expansion Program

• New State Health Insurance Exchange (also called Online Marketplace) Programs

2. Prevalence Categories

• Serious Mental Illness

• Serious Psychological Distress

• Substance Use Disorders

Data Displayed Nationally – State-by-State

3. Characteristics (e.g., Age, Race)

4. Utilization Data (e.g., Projected use of outpatient treatment)

Resource Management Map

Percentage and Number of Uninsured with a

Behavioral Health Condition Aged 18-64 Who are

Eligible Under the Current Medicaid Program and

for ACA Coverage Expansions State-by-State, 2011

9

[SECTION I] 1. NATIONAL FINDINGS

National Projections of Uninsured People Ages 18-64 Years with a Mental Illness or Substance Use Condition for Health Insurance Under New ACA

Coverage Programs, 2011

Figure 1

Figure 2

Percent with a Serious

Mental Illness

Percent with a Serious

Mental Illness

Percent with a Substance

Use Disorder

(2,756,040)

(1,328,060) (2,792,180) (2,579,600)

7.1 %

(1,175,600)

6.1%

(2,601,000)

Percent with a Substance

Use Disorder

Percent with Serious

Psychological Distress

Percent with Serious

Psychological Distress

10

[SECTION II] 1. STATE FINDINGS ON COVERAGE

A. SERIOUS MENTAL ILLNESS (SMI) B. SERIOUS PSYCHOLOGICAL DISORDER (SPD) C. SUBSTANCE USE DISORDER (SUD)

2. ADDITIONAL STATE DATA

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Table 1

Eligible for Coverage under the Current Medicaid Program

State

Total # Eligible

(2010)

% of people with

SMI (2011)

Number with

SMI (2011)

Total # Eligible

(2011)

% of people with

SMI (2011)

Number with

SMI (2011)

Total # Eligible

(2011)

% of people with

SMI (2011)

Number with

SMI (2011)

Connecticut 244,062 7.5 18,305 93,152 12.2 11,365 141,139 3 4,234

Maine 137,303 12.1 16,614 46,054 9.3 4,283 62,862 1.5 943

Massachusetts 689,746 12.8 88,287 85,127 9.2 7,832 125,116 9.3 11,636

New Hampshire 48,156 26.5 12,761 42,006 7.7 3,234 61,073 5.7 3,481

Rhode Island 69,218 13.2 9,137 41,449 8.2 3,399 50,369 13 6,548

Vermont 69,273 19.0 13,162 11,285 14.1 1,591 23,550 10.7 2,520

TOTAL 1,257,758 12.6 158,266 319,073 9.9 31,704 464,109 6.3 29,362

New Jersey 420,401 10.7 44,983 362,863 4.3 15,603 505,571 8.7 43,985

New York 1,922,217 9.5 182,611 730,631 4 29,225 984,185 5.1 50,193

TOTAL 2,342,618 9.7 227,594 1,093,494 4.1 44,828 1,489,756 6.3 94,178

District of Columbia 83,269 3.5 2,914 19,914 7 1,394 14,838 7 1,039

Delaware 73,606 12.8 9,422 25,146 13 3,269 36,434 3.5 1,275 Maryland 284,832 8.9 25,350 184,478 2.4 4,427 252,507 3.3 8,333

Pennsylvania 765,626 15.7 120,203 502,119 6.3 31,633 546,597 4.3 23,504

Virginia 285,665 8.0 22,853 370,603 9.3 34,466 416,151 7.3 30,379

West Virginia 118,470 17.7 20,969 132,909 11.8 15,683 115,556 9.3 10,747

TOTAL 1,611,468 12.5 201,712 1,235,169 7.4 90,873 1,382,083 5.4 75,276

Alabama 245,474 11.7 28,720 347,467 16.2 56,290 244,715 8.7 21,290

Florida 852,351 8.6 73,302 1,577,102 7.7 121,437 1,644,960 4.9 80,603

Georgia 365,252 15.7 57,345 872,733 3.8 33,164 727,507 2.1 15,278

Kentucky 248,933 14.9 37,091 317,314 10 31,731 234,748 7.8 18,310

Mississippi 193,864 8.7 16,866 264,654 10.1 26,730 188,299 8.5 16,005

North Carolina 474,177 8.0 37,934 685,664 3.6 24,684 625,217 4.8 30,010

South Carolina 259,360 7.9 20,489 358,217 11.4 40,837 293,792 3.5 10,283

Tennessee 418,015 16.2 67,718 433,575 6.9 29,917 392,675 4.2 16,492

TOTAL 3,057,426 11.1 339,466 4,856,726 7.5 364,789 4,351,913 4.8 208,272

Illinois 769,762 9.4 72,358 672,156 5.4 36,296 724,820 6.8 49,288

Indiana 320,503 22.0 70,511 398,100 17.1 68,075 384,965 6.7 25,793

Michigan 715,204 10.8 77,242 527,439 8.3 43,777 484,692 7.2 34,898

Minnesota 351,000 13.0 45,630 149,609 16.9 25,284 195,903 9.6 18,807

Ohio 747,278 16.1 120,312 587,013 12.4 72,790 564,194 7.9 44,571

Wisconsin 415,529 15.1 62,745 210,975 10.4 21,941 218,051 12 26,166

TOTAL 3,319,276 13.5 448,797 2,545,292 10.5 268,164 2,572,625 7.8 199,522

Arkansas 150,048 16.0 24,008 231,245 10.3 23,818 214,089 10.2 21,837

Louisiana 267,466 9.1 24,339 381,276 7.4 28,214 318,083 5.6 17,813

New Mexico 145,956 11.7 17,077 173,370 5 8,669 164,622 7.9 13,005

Oklahoma 163,197 7.8 12,729 314,145 7.3 22,933 249,504 7.8 19,461

Texas 959,640 7.9 75,812 2,319,063 5.9 136,825 2,283,862 5.5 125,612

TOTAL 1,686,307 9.1 153,965 3,419,099 6.4 220,458 3,230,160 6.1 197,729

Iowa 165,058 18.3 30,206 110,895 9.9 10,979 110,986 6 6,659

Kansas 83,341 15.9 13,251 155,176 6.4 9,931 144,679 8.6 12,442

Missouri 299,191 22.4 67,019 264,654 7.9 20,908 319,621 9.4 30,044

Nebraska 65,103 9.9 6,445 81,256 9.1 7,394 89,621 10.7 9,589

TOTAL 612,693 19.1 116,921 611,981 8.0 49,212 664,907 8.8 58,735

Colorado 218,197 12.5 27,275 265,071 4.7 12,458 320,107 5.9 18,886

Montana 30,653 14.0 4,291 68,442 7.3 4,996 76,840 5.7 4,380

North Dakota 19,476 4.9 954 24,538 6.9 1,693 26,066 7.4 1,929

South Dakota 27,468 5.5 1,511 38,038 5.7 2,168 36,873 5.2 1,917

Utah 89,208 24.8 22,124 149,825 14.2 21,275 149,296 9.6 14,332

Wyoming 15,760 14.9 2,348 22,534 11.6 2,614 36,526 8.9 3,251

TOTAL 400,762 14.6 58,503 568,448 8.0 45,205 645,708 6.9 44,696

Arizona 544,729 15.1 82,254 434,948 7.1 30,881 414,300 4.1 16,986

California 2,426,211 7.8 189,244 2,517,590 5 125,880 2,948,753 5 147,438

Hawaii 83,070 12.2 10,135 35,669 3.7 1,320 36,496 12.2 4,453

Nevada 82,553 27.7 22,867 211,027 4 8,441 234,424 7.8 18,285

TOTAL 3,136,563 9.7 304,500 3,199,234 5.2 166,522 3,633,973 5.2 187,162

Alaska 34,524 9.5 3,280 33,205 3.8 1,262 63,356 9.6 6,082

Idaho 48,069 17.4 8,364 98,726 13.3 13,131 103,029 12.7 13,085

Oregon 176,710 25.0 44,178 253,123 10.6 26,831 256,909 6.7 17,213

Washington 329,096 17.8 58,579 366,946 7 25,686 408,469 6.4 26,142

TOTAL 588,399 19.4 114,400 752,000 8.9 66,910 831,763 7.5 62,522

Source: National Survey on Drug Use and Health, 2008-2011

Percentage and Number of Uninsured People Ages 18-64 with a Serious Mental Illness (SMI) Eligible for Health Insurance under

New Medicaid Expansion Program and New State Health Insurance Exchange in the Affordable Care Act (ACA), and

Current Medicaid Population Health Insurance Exchange PopulationMedicaid Expansion Population

12

Key Findings

Number of Uninsured People Ages 18-64 in Florida with a Serious Mental Illness (SMI)

Eligible for Health Insurance under the New Medicaid Expansion Program and the New

State Health Insurance Exchange in the Affordable Care Act (ACA), and Eligible for

Coverage under the Current Medicaid Program, 2011

1. Nearly 121,000 individuals (121,436) who are uninsured in Florida (not covered by a

public or private health insurance program) with a serious mental illness (e.g.,

schizophrenia, bipolar disorder, major depression) are eligible for health insurance

coverage under the New Medicaid Expansion Program in the Affordable Care Act

(ACA).

2. Nearly 81,000 (80,603) individuals who are uninsured in Florida (not covered by a public

or private health insurance program) with a serious mental illness (e.g., schizophrenia,

bipolar disorder, major depression) are eligible for health insurance coverage under the

New State Health Insurance Exchange (online marketplace) in the Affordable Care Act

(ACA).

3. Nearly 202,000 (202,039) individuals who are uninsured in Florida (not covered by a



coverage under the New Medicaid Expansion Program and the New State Health

Insurance Exchange in the Affordable Care Act (ACA).

4. Nearly 73,000 (73,302) individuals who are uninsured in Florida (not covered by a public

or private health insurance program) with a serious mental illness (e.g., schizophrenia,

bipolar disorder, major depression) are eligible for health insurance coverage under the

Current State Medicaid Program already operating in the state and in place prior to the

passage of the Affordable Care Act (ACA).

5. Nearly 275,000 (275,342) individuals who are uninsured in Florida (not covered by a



coverage under the New Medicaid Expansion Program and the New State Health

Insurance Exchange in the Affordable Care Act (ACA), and eligible for coverage under

the Current State Medicaid Program.

13

Figu

re 4

So

urc

e: N

atio

nal

Su

rvey

on

Dru

g U

se a

nd

Hea

lth

, 20

08

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11

05

10

15

20

25

30

35

40

45

50

21

.2

15

.9

10

.6

19

.6

14

.9

10

.3

Prevalence Rate (%)

Flo

rid

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ori

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20

11

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Me

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P

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s: N

ew

Yo

rk, U

S

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sure

d P

eo

ple

Age

s 1

8-6

4 in

Flo

rid

a w

ith

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rio

us

Psy

cho

logi

cal D

istr

ess

(SP

D)

Elig

ible

fo

r H

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th In

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nce

in t

he

Cu

rre

nt

Me

dic

aid

Pro

gram

; an

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the

Ne

w M

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icai

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ansi

on

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gram

an

d N

ew

Sta

te H

eal

th In

sura

nce

Exc

han

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th

e A

ffo

rdab

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are

Act

(2

01

0 v

s. 2

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1)

Me

dic

aid

Exp

ansi

on

P

op

ula

tio

n

14

Table 2


State

Total # Eligible

(2010)

% of people with

SPD (2011)

Number with

SPD (2011)

Total # Eligible

(2011)

% of people with

SPD (2011)

Number with

SPD (2011)

Total # Eligible

(2011)

% of people with

SPD (2011)

Number with

SPD (2011)

Connecticut 244,062 23.1 56,378 93,152 20 18,630 141,139 9.6 13,549

Maine 137,303 21.8 29,932 46,054 17.9 8,244 62,862 9.4 5,909

Massachusetts 689,746 18 124,154 85,127 10.4 8,853 125,116 17.9 22,396

New Hampshire 48,156 43.5 20,948 42,006 13.1 5,503 61,073 14.3 8,733

Rhode Island 69,218 24.3 16,820 41,449 15.9 6,590 50,369 27.3 13,751

Vermont 69,273 29.2 20,228 11,285 23.3 2,629 23,550 20.2 4,757

TOTAL 1,257,758 21.3 268,460 319,073 15.8 50,450 464,109 14.9 69,095

New Jersey 420,401 22.1 92,909 362,863 7.5 27,215 505,571 14.2 71,791

New York 1,922,217 20.9 401,743 730,631 12.1 88,406 984,185 11.2 110,229

TOTAL 2,342,618 21.1 494,652 1,093,494 10.6 115,621 1,489,756 12.2 182,020

District of Columbia 83,269 10.8 8,993 19,914 13.7 2,728 14,838 10.6 1,573

Delaware 73,606 23.4 17,224 25,146 20.2 5,079 36,434 7.5 2,733

Maryland 284,832 21.4 60,954 184,478 11.4 21,030 252,507 9.2 23,231 Pennsylvania 765,626 27.7 212,078 502,119 15.1 75,820 546,597 14.6 79,803

Virginia 285,665 20 57,133 370,603 20.3 75,232 416,151 19.2 79,901

West Virginia 118,470 31.9 37,792 132,909 23.7 31,499 115,556 18.1 20,916

TOTAL 1,611,468 24.5 394,174 1,235,169 17.1 211,390 1,382,083 15.1 208,156

Alabama 245,474 20.2 49,586 347,467 24 83,392 244,715 20.4 49,922

Florida 852,351 19.6 167,061 1,577,102 14.9 234,988 1,644,960 10.3 169,431

Georgia 365,252 22.2 81,086 872,733 11.4 99,492 727,507 5.1 37,103

Kentucky 248,933 25.8 64,225 317,314 19.2 60,924 234,748 13.7 32,160

Mississippi 193,864 19.3 37,416 264,654 19.5 51,608 188,299 15.7 29,563

North Carolina 474,177 24.4 115,699 685,664 11.4 78,166 625,217 11.8 73,776

South Carolina 259,360 14.3 37,088 358,217 20.3 72,718 293,792 17.6 51,707

Tennessee 418,015 25.4 106,176 433,575 18.7 81,079 392,675 15.1 59,294

TOTAL 3,057,426 21.5 658,336 4,856,726 15.7 762,366 4,351,913 11.6 502,956

Illinois 769,762 18 138,557 672,156 12.5 84,020 724,820 14.7 106,549

Indiana 320,503 30.9 99,035 398,100 24.3 96,738 384,965 16 61,594

Michigan 715,204 23.5 168,073 527,439 18.7 98,631 484,692 15.3 74,158

Minnesota 351,000 20.8 73,008 149,609 26.6 39,796 195,903 18.9 37,026

Ohio 747,278 26 194,292 587,013 24.7 144,992 564,194 16.2 91,399

Wisconsin 415,529 29.3 121,750 210,975 17.6 37,132 218,051 17.8 38,813

TOTAL 3,319,276 23.9 794,716 2,545,292 19.7 501,309 2,572,625 15.9 409,539

Arkansas 150,048 24.3 36,462 231,245 22.8 52,724 214,089 21.1 45,173

Louisiana 267,466 21.7 58,040 381,276 16.5 62,911 318,083 14.8 47,076

New Mexico 145,956 24.5 35,759 173,370 14.7 25,485 164,622 11.5 18,932

Oklahoma 163,197 18.1 29,539 314,145 17.5 54,975 249,504 17.8 44,412

Texas 959,640 17.4 166,977 2,319,063 11.4 264,373 2,283,862 12.6 287,767

TOTAL 1,686,307 19.4 326,777 3,419,099 13.5 460,468 3,230,160 13.7 443,359

Iowa 165,058 32.7 53,974 110,895 19.2 21,292 110,986 13.1 14,539

Kansas 83,341 26 21,669 155,176 14 21,725 144,679 15.8 22,859

Missouri 299,191 35.4 105,914 264,654 15.3 40,492 319,621 14.2 45,386

Nebraska 65,103 23.2 15,104 81,256 24.2 19,664 89,621 20 17,924

TOTAL 612,693 32.1 196,660 611,981 16.9 103,172 664,907 15.1 100,709

Colorado 218,197 31.3 68,296 265,071 12.4 32,869 320,107 13.9 44,495

Montana 30,653 22.6 6,928 68,442 15.7 10,745 76,840 15.4 11,833

North Dakota 19,476 16.8 3,272 24,538 14 3,435 26,066 15.7 4,092

South Dakota 27,468 25.2 6,922 38,038 20.5 7,798 36,873 12.3 4,535

Utah 89,208 45.6 40,679 149,825 24.4 36,557 149,296 15.4 22,992

Wyoming 15,760 22.7 3,578 22,534 17.1 3,853 36,526 17.6 6,429

TOTAL 400,762 32.4 129,674 568,448 16.8 95,258 645,708 14.6 94,376

Arizona 544,729 24 130,735 434,948 13.8 60,023 414,300 17.4 72,088

California 2,426,211 15.3 371,210 2,517,590 11.2 281,970 2,948,753 11.9 350,902

Hawaii 83,070 20.3 16,863 35,669 9.2 3,282 36,496 13.7 5,000

Nevada 82,553 34.5 28,481 211,027 11.4 24,057 234,424 12.9 30,241

TOTAL 3,136,563 17.4 547,289 3,199,234 11.5 369,332 3,633,973 12.6 458,230

Alaska 34,524 14 4,833 33,205 18.6 6,176 63,356 13.7 8,680

Idaho 48,069 30.6 14,709 98,726 22.7 22,411 103,029 20.1 20,709

Oregon 176,710 35.1 62,025 253,123 20.7 52,396 256,909 12.7 32,627

Washington 329,096 27.4 90,172 366,946 11.4 41,832 408,469 14.5 59,228

TOTAL 588,399 29.2 171,740 752,000 16.3 122,815 831,763 14.6 121,244


Current Medicaid Population Health Insurance Exchange Population

Percentage and Number of Uninsured People Ages 18-64 with Serious Psychological Distress (SPD) Eligible for Health Insurance under


Medicaid Expansion Population

15

Key Findings

Number of Uninsured People Ages 18-64 in Florida with Serious Psychological Distress

(SPD) Eligible for Health Insurance under the New Medicaid Expansion Program and the

New State Health Insurance Exchange in the Affordable Care Act (ACA), and Eligible for


1. Nearly 235,000 adults (234,988) who are uninsured in Florida (not covered by a public or

private health insurance program) who are in serious psychological distress (e.g., severe

panic, anxiety, or mood disorders) are eligible for health insurance coverage under the

New Medicaid Expansion Program in the Affordable Care Act (ACA).

2. Nearly 169,500 (169,430) adults who are uninsured in Florida (not covered by a public or




(ACA).




New Medicaid Expansion Program and the New State Health Insurance Exchange in

the Affordable Care Act (ACA).










the Affordable Care Act (ACA), and the Current State Medicaid Program.

16

Figu

re 5

So

urc

e: N

atio

nal

Su

rvey

on

Dru

g U

se a

nd

Hea

lth

, 20

08

-20

11

05

10

15

20

25

30

35

40

45

50

12

.2

11

.5

13

.7

12

.1

11

.3

13

.7

Prevalence Rate (%)

Flo

rid

a 2

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ork

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(2

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ata)

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eo

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Age

s 1

8-6

4 in

Flo

rid

a w

ith

a S

ub

stan

ce U

se D

iso

rde

r (S

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)

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r H

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th In

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in t

he

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rre

nt

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dic

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gram

; an

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gram

an

d t

he

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tate

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alth

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xch

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in t

he

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ct

(20

10

vs.

20

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dic

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op

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17

Table 3


State

Total # Eligible

(2010)

% of people with

SUD (2011)

Number with

SUD (2011)

Total # Eligible

(2011)

% of people with

SUD (2011)

Number with

SUD (2011)

Total # Eligible

(2011)

% of people with

SUD (2011)

Number with

SUD (2011)

Connecticut 244,062 17 52,717 93,152 24.4 22,729 141,139 15.1 21,312

Maine 137,303 11.8 14,554 46,054 17.8 8,198 62,862 12.6 7,921

Massachusetts 689,746 17.3 122,775 85,127 25.7 21,878 125,116 18.1 22,646

New Hampshire 48,156 9.5 4,382 42,006 19.4 8,149 61,073 16.7 10,199

Rhode Island 69,218 12.8 11,075 41,449 21.1 8,746 50,369 29.6 14,909

Vermont 69,273 18.3 12,400 11,285 20.3 2,291 23,550 12 2,826

TOTAL 1,257,758 17.3 217,903 319,073 22.6 71,990 464,109 17.2 79,813

New Jersey 420,401 15.9 79,456 362,863 9.2 33,383 505,571 11.5 58,141

New York 1,922,217 11.5 257,577 730,631 12.9 94,251 984,185 12.6 124,007

TOTAL 2,342,618 14.4 337,033 1,093,494 11.7 127,635 1,489,756 12.2 182,148

District of Columbia 83,269 16 13,906 19,914 30.5 6,074 14,838 19.7 2,923

Delaware 73,606 15.1 8,686 25,146 10.9 2,741 36,434 13.8 5,028

Maryland 284,832 14.7 41,016 184,478 9.8 18,079 252,507 12 30,301 Pennsylvania 765,626 15.6 105,656 502,119 18.9 94,900 546,597 16.1 88,002

Virginia 285,665 7.3 16,854 370,603 18.3 67,820 416,151 23.2 96,547

West Virginia 118,470 11.7 18,007 132,909 16 21,265 115,556 8.9 10,284

TOTAL 1,611,468 12.7 204,125 1,235,169 17.1 210,880 1,382,083 16.9 233,085

Alabama 245,474 6.8 19,147 347,467 10.6 36,832 244,715 12.8 31,324

Florida 852,351 12.1 103,987 1,577,102 11.3 178,213 1,644,960 13.7 225,360

Georgia 365,252 12 53,327 872,733 11.4 99,492 727,507 11.3 82,208

Kentucky 248,933 10.9 32,859 317,314 13.8 43,789 234,748 10.6 24,883

Mississippi 193,864 5.5 13,377 264,654 9.5 25,142 188,299 11.4 21,466

North Carolina 474,177 11.4 56,427 685,664 12.5 85,708 625,217 13.4 83,779

South Carolina 259,360 11 28,011 358,217 19.1 68,419 293,792 14 41,131

Tennessee 418,015 10.7 51,416 433,575 18.4 79,778 392,675 19.6 76,964

TOTAL 3,057,426 11.7 358,550 4,856,726 12.7 617,372 4,351,913 13.5 587,115

Illinois 769,762 10.3 73,127 672,156 13.6 91,413 724,820 16.2 117,421

Indiana 320,503 11 40,704 398,100 21.1 83,999 384,965 8.6 33,107

Michigan 715,204 12.6 88,685 527,439 16.2 85,445 484,692 17.6 85,306

Minnesota 351,000 14.4 59,319 149,609 15.4 23,040 195,903 16.9 33,108

Ohio 747,278 14.6 110,597 587,013 20.4 119,751 564,194 18.7 105,504

Wisconsin 415,529 13.6 66,485 210,975 13.4 28,271 218,051 13.5 29,437

TOTAL 3,319,276 13.2 438,917 2,545,292 17.0 431,919 2,572,625 15.7 403,882

Arkansas 150,048 10.5 14,555 231,245 11.7 27,056 214,089 13.5 28,902

Louisiana 267,466 10.2 30,491 381,276 18.8 71,680 318,083 12.1 38,488

New Mexico 145,956 15.8 25,834 173,370 8.9 15,430 164,622 19.2 31,607

Oklahoma 163,197 11.2 19,910 314,145 14 43,980 249,504 19.5 48,653

Texas 959,640 9.1 96,924 2,319,063 10.8 250,459 2,283,862 12.6 287,767

TOTAL 1,686,307 11.1 187,714 3,419,099 12.0 408,605 3,230,160 13.5 435,417

Iowa 165,058 12.9 19,642 110,895 14.7 16,302 110,986 15.4 17,092

Kansas 83,341 11.3 10,334 155,176 12.6 19,552 144,679 18.1 26,187

Missouri 299,191 12.4 38,596 264,654 14.8 39,169 319,621 8.3 26,529

Nebraska 65,103 10.5 6,966 81,256 17.2 13,976 89,621 19.3 17,297

TOTAL 612,693 12.3 75,538 611,981 14.5 88,999 664,907 13.1 87,104

Colorado 218,197 15.2 27,929 265,071 12.5 33,134 320,107 24.4 78,106

Montana 30,653 20.4 7,111 68,442 19.2 13,141 76,840 15.3 11,757

North Dakota 19,476 14.9 1,889 24,538 20 4,908 26,066 22 5,735

South Dakota 27,468 26.7 5,521 38,038 19 7,227 36,873 16.1 5,937

Utah 89,208 9.8 11,865 149,825 8.2 12,286 149,296 10.7 15,975

Wyoming 15,760 17.3 2,396 22,534 12.4 2,794 36,526 15.5 5,662

TOTAL 400,762 14.2 56,711 568,448 12.9 73,489 645,708 19.1 123,170

Arizona 544,729 16.1 78,441 434,948 19.4 84,380 414,300 14.6 60,488

California 2,426,211 9 213,507 2,517,590 9.7 244,206 2,948,753 13.8 406,928

Hawaii 83,070 16.1 13,956 35,669 15.4 5,493 36,496 17.5 6,387

Nevada 82,553 23 13,621 211,027 14.3 30,177 234,424 18.5 43,368

TOTAL 3,136,563 10.2 319,525 3,199,234 11.4 364,256 3,633,973 14.2 517,171

Alaska 34,524 12.6 3,798 33,205 15.2 5,047 63,356 14.8 9,377

Idaho 48,069 14.2 8,604 98,726 22.3 22,016 103,029 11 11,333

Oregon 176,710 17.9 37,286 253,123 15.5 39,234 256,909 16.4 42,133

Washington 329,096 9.3 38,175 366,946 21.7 79,627 408,469 10.6 43,298

TOTAL 588,399 14.9 87,863 752,000 19.4 145,924 831,763 12.8 106,141


Current Medicaid Population Health Insurance Exchange Population

Percentage and Number of Uninsured People Ages 18-64 with a Substace Use Disorder (SUD) Eligible for Health Insurance under


Medicaid Expansion Population

18

Key Findings

Number of Uninsured People Ages 18-64 in Florida with Substance Use Disorder (SUD)

Eligible for Health Insurance under the New Medicaid Expansion Program and the New

State Health Insurance Exchange in the Affordable Care Act (ACA), and Eligible for


1. Nearly 178,500 adults (178,212) who are uninsured in Florida (not covered by a public or

private health insurance program) with a substance use disorder (e.g., dependence or

abuse can involve alcohol, cocaine, heroin, and many individuals have a co-occurring

mental health condition such as schizophrenia or an anxiety disorder) are eligible for

health insurance coverage under the New Medicaid Expansion Program in the

Affordable Care Act (ACA).


private health insurance program) with a substance use disorder (e.g., alcohol, cocaine,

heroin and many individuals have a co-occurring mental health condition such as

schizophrenia or an anxiety disorder) are eligible for health insurance coverage under the


(ACA).






the Affordable Care Act (ACA).












the Affordable Care Act (ACA), and eligible for coverage under the Current State

Medicaid Program.

19

Nearly 357,000 (356,425) uninsured adults in Florida with a mental health condition

(persons with either a serious mental illness or in serious psychological distress) are

eligible for health insurance coverage under the New Medicaid Expansion Program.

Nearly 535,000 (534,637) uninsured adults in Florida with a behavioral health

condition (people with a serious mental illness, in serious psychological distress, or with

a substance use disorder) are eligible for health insurance coverage under the New

Medicaid Expansion Program.

The 535,000 uninsured adults in Florida with a behavioral health condition represent

34 percent of the total adults 1,577,102 in the state who are eligible for coverage under

the New Medicaid Expansion Program.

*****



eligible for coverage under the new State Health Insurance Exchange Program.


condition (people with a serious mental illness, in serious psychological distress, or with

a substance use disorder) are eligible for coverage under the new State Health

Insurance Exchange Program.


29 percent of the total persons 1,644,960 in the state who are eligible for coverage under

the new State Health Insurance Exchange Program.

*****



eligible for coverage under the Current State Medicaid Program.


condition (people with a serious mental illness, in serious psychological distress or with

a substance use disorder) are eligible for coverage under the Current State Medicaid

Program.

Additional Findings for Florida

20

The nearly 847,000 uninsured adults with a mental health condition (persons with either a serious

mental illness or in serious psychological distress) in Florida represent (21 percent) of the 4,074,413

uninsured adults eligible for coverage in the state under the three health insurance programs

(Current Medicaid, New Medicaid, New Exchanges).

The nearly 1,354,500 uninsured adults with a behavioral health condition (people with a serious

mental illness, in serious psychological distress, or with a substance use disorder) in Florida represent

(33 percent) of the 4,074,413 uninsured adults eligible for coverage in the state under the three health

insurance programs.


40 percent of the total persons 852,351 in the state who are eligible for coverage under

the Current State Medicaid Program.

21

[SECTION III] 1. STATE FINDINGS FOR SPECIAL POPULATIONS

A. UNINSURED CHILDREN WITH A SERIOUS EMOTIONAL DISTURBANCE

B. UNINSURED VETERANS WITH A MENTAL ILLNESS

Table 4

Total Children Under 18 Years, All Income

Levels

At or Below 200% of Poverty Without

Health Insurance

At 200% of Poverty Without Health

Insurance With a Serious Emotional

Disturbance

United States 78,304,000 5,122,000 1,024,400

Connecticut 869,000 25,000 5,000

Maine 288,000 6,000 1,200

Massachusetts 1,529,000 28,000 5,600

New Hampshire 299,000 6,000 1,200

Rhode Island 240,000 11,000 2,200

Vermont 132,000 3,000 600

Total 3,357,000 79,000 15,800

New Jersey 2,184,000 113,000 22,600

New York 4,594,000 213,000 42,600

Total 6,778,000 326,000 65,200

District of Columbia 221,000 10,000 2,000

Delaware 109,000 5,000 1,000

Maryland 1,424,000 75,000 15,000

Pennsylvania 2,936,000 142,000 28,400

Virginia 1,989,000 87,000 17,400

West Virginia 410,000 16,000 3,200

Total 7,089,000 335,000 67,000

Alabama 1,200,000 74,000 14,800

Florida 4,164,000 422,000 84,400

Georgia 2,643,000 199,000 39,800

Kentucky 1,068,000 50,000 10,000

Mississippi 808,000 62,000 12,400

North Carolina 2,439,000 174,000 34,800

South Carolina 1,139,000 100,000 20,000

Tennessee 1,563,000 87,000 17,400

Total 15,024,000 1,168,000 233,600

Illinois 3,290,000 171,000 34,200

Indiana 1,730,000 75,000 15,000

Michigan 2,478,000 82,000 16,400

Minnesota 1,341,000 55,000 11,000

Ohio 2,843,000 170,000 34,000

Wisconsin 1,396,000 39,000 7,800

Total 13,078,000 592,000 118,400

Arkansas 735,000 45,000 9,000

Louisiana 1,207,000 73,000 14,600

New Mexico 541,000 52,000 10,400

Oklahoma 986,000 62,000 12,400

Texas 7,247,000 813,000 162,600

Total 10,716,000 1,045,000 209,000

Iowa 767,000 33,000 6,600

Kansas 755,000 39,000 7,800

Missouri 1,488,000 107,000 21,400

Nebraska 484,000 24,000 4,800

Total 3,494,000 203,000 40,600

Colorado 1,304,000 87,000 17,400

Montana 230,000 16,000 3,200

North Dakota 161,000 7,000 1,400

South Dakota 210,000 11,000 2,200

Utah 914,000 65,000 13,000

Wyoming 144,000 7,000 1,400

Total 2,963,000 193,000 38,600

Arizona 1,711,000 183,000 36,600

California 9,838,000 735,000 147,000

Hawaii 327,000 6,000 1,200

Nevada 693,000 82,000 16,400

Total 12,569,000 1,006,000 201,200

Alaska 199,000 12,000 2,400

Idaho 450,000 34,000 6,800

Oregon 894,000 56,000 11,200

Washington 1,694,000 75,000 15,000

Total 3,237,000 177,000 35,400

2009-2011, with a Serious Emotional Disturbance

Number of Children 18 Years of Age or Younger, At or Below 200 Percent of FPL

22

Table 5

Total Below 138% FPL Below 138% FPL with Mental

Illness (33%)

Above 138% FPL Above 138% FPL with Mental

Illness (33%)

United States 1,311,510 535,000 176,550 776,400 256,212

Connecticut 7,300 2,600 858 4,700 1,551

Maine 7,600 2,700 891 4,900 1,617

Massachusetts 7,800 2,600 858 5,200 1,716

New Hampshire 6,200 1,500 495 4,700 1,551

Rhode Island 3,400 1,100 363 2,300 759

Vermont 1,800 400 132 1,300 429

Total 34,100 10,900 3,597 23,100 7,623

New Jersey 19,200 7,300 2,409 11,900 3,927

New York 38,300 14,400 4,752 23,900 7,887

Total 57,500 21,700 7,161 35,800 11,814

District of Columbia 1,600 900 297 700 231

Delaware 3,500 1,200 396 2,300 759

Maryland 17,700 6,900 2,277 10,800 3,564

Pennsylvania 45,500 19,100 6,303 26,400 8,712

Virginia 32,100 12,300 4,059 19,800 6,534

West Virginia 11,300 5,300 1,749 6,000 1,980

Total 111,700 45,700 15,081 66,000 21,780

Alabama 26,800 13,000 4,290 13,800 4,554

Florida 103,700 41,200 13,596 62,500 20,625

Georgia 56,300 24,900 8,217 31,400 10,362

Kentucky 20,600 9,500 3,135 11,100 3,663

Mississippi 16,200 7,100 2,343 9,000 2,970

North Carolina 52,700 23,300 7,689 29,500 9,735

South Carolina 28,900 13,000 4,290 15,900 5,247

Tennessee 35,300 15,800 5,214 19,600 6,468

Total 340,500 147,800 48,774 192,800 63,624

Illinois 41,900 17,600 5,808 24,300 8,019

Indiana 31,000 13,700 4,521 17,300 5,709

Michigan 44,100 20,100 6,633 24,100 7,953

Minnesota 15,500 5,400 1,782 10,100 3,333

Ohio 51,600 24,600 8,118 27,100 8,943

Wisconsin 16,700 6,400 2,112 10,300 3,399

Total 200,800 87,800 28,974 113,200 37,356

Arkansas 20,300 8,500 2,805 11,800 3,894

Louisiana 26,200 9,900 3,267 16,300 5,379

New Mexico 12,600 5,200 1,716 7,400 2,442

Oklahoma 26,400 10,000 3,300 16,500 5,445

Texas 130,300 48,900 16,137 81,400 26,862

Total 215,800 82,500 27,225 133,400 44,022

Iowa 10,100 3,800 1,254 6,300 2,079

Kansas 14,400 5,700 1,881 8,800 2,904

Missouri 30,900 12,800 4,224 18,200 6,006

Nebraska 6,600 2,100 693 4,500 1,485

Total 62,000 24,400 8,052 37,800 12,474

Colorado 25,500 9,500 3,135 16,000 5,280

Montana 9,200 4,000 1,320 5,200 1,716

North Dakota 1,700 700 231 1,000 330

South Dakota 4,100 1,600 528 2,600 858

Utah 9,800 3,800 1,254 6,000 1,980

Wyoming 4,200 1,200 396 2,900 957

Total 54,500 20,800 6,864 33,700 11,121

Arizona 29,600 10,700 3,531 18,900 6,237

California 106,800 45,800 15,114 60,900 20,097

Hawaii 3,600 1,900 627 1,700 561

Nevada 15,900 6,000 1,980 9,900 3,267

Total 155,900 64,400 21,252 91,400 30,162

Alaska 6,400 2,400 792 4,100 1,353

Idaho 10,000 3,800 1,254 6,200 2,046

Oregon 26,000 10,800 3,564 15,100 4,983

Washington 36,100 12,200 4,026 23,900 7,887

Total 78,500 29,200 9,636 49,300 16,269

Number of Uninsured Veterans (18-64), by State and Income Group (2008-2010)

23

[SECTION IV] DEMOGRAPHIC CHARACTERISTICS

A. NATIONAL RATES B. CHARACTERISTICS-SMI POPULATION C. CHARACTERISTICS-SUD POPULATION D. CHARACTERISTICS- UNINSURED PEOPLE

18-34 YEARS OF AGE BY STATE

Table 6

Percent with

SMI

Percent with

SPD

Percent with

SUD

Percent with

SMI

Percent with

SPD

Percent with

SUD

Gender

Male 4.9 12.3 20.5 4.2 10.6 18.7

Female 9 17.6 7.7 8.4 17 9.2

Age

18-34 7.3 17.2 17.6 7 16.2 20.8

35+ 6.6 12.7 10.7 4.9 10.4 8.5

Race/Ethnicity

Non-Hispanic White 11.1 21.4 17.3 8.1 16.3 15.9

Non-Hispanic Black 4.9 12.9 15.2 4.1 10.8 14.5

Non-Hispanic Other 6.3 12.7 9.7 4.5 10.7 11

Hispanic 3.3 8.8 10.7 2.9 9 12.9

Education

< High School 5.5 13.2 15.6 4.4 10.9 15.6

High School Graduate 7.8 15.1 13.2 6.3 13.6 15.4

College 8.1 17.4 13.4 6.7 14.6 13.4

Population Density

Core Based Statistical Area: 1 million

+ 5.6 12.7 13 5.8 13 15.3

Core Based Statistical Area: < 1

million 8 17.6 15.8 6 13.9 14.4

Non- Core Based Statistical Area 8.9 17.1 14.8 6.7 13.5 13

Overall Health

Excellent 3.5 8.9 10.4 3.4 8.4 10.6Very Good 5.5 13.4 14.1 5.5 12.8 16.2

Good 6.1 14.4 14 6.3 14 15

Fair/Poor 14.5 24.6 18.4 11.7 22.8 16.7

Source: SAMHSA, 2011

< 139% FPL 139-399% FPL

National Prevalence Rates for Behavioral Health Populations among Uninsured Adults Aged 18 to 64 by Federal Poverty

Level and Demographic Characteristics

24

Ch

ara

cte

risti

cs o

f 18-6

4 Y

ear-

Old

s w

ith

a S

eri

ou

s M

en

tal

Illn

es

s (

SM

I) P

roje

cte

d i

n M

ed

icaid

Exp

an

sio

n P

op

ula

tio

n*

• F

em

ale

• N

on-H

ispanic

White

• H

igh S

chool G

raduate

* P

opu

lation w

ith incom

e less than 1

39%

of

the F

edera

l P

overt

y L

evel and u

nin

sure

d

Na

tio

na

l

Flo

rid

a

F

em

ale

6

1%

6

1%

A

ge

18

-34

5

3%

4

9%

R

ac

e/E

thn

icit

y

N

on

-His

pa

nic

White

66

%

62

%

N

on

-His

pa

nic

Bla

ck

13

%

18

%

O

the

r 5

%

3%

H

isp

an

ic

16

%

18

%

E

du

ca

tio

n

<

Hig

h S

ch

oo

l 2

6%

2

4%

H

igh

Sch

oo

l G

rad

ua

te

38

%

40

%

C

olle

ge

37

%

37

%

Sourc

es: 2008 –

2010 N

ational S

urv

ey o

n D

rug U

se a

nd H

ealth (

Revis

ed M

arc

h 2

012)

2

010 A

merican C

om

munity S

urv

ey

10

Mo

st

co

mm

on

ch

ara

cte

risti

cs o

f

pers

on

s w

ith

SM

I in

Me

dic

aid

exp

an

sio

n p

op

ula

tio

n i

n F

lori

da i

s:

25

Ch

ara

cte

risti

cs o

f 18-6

4 Y

ear-

Old

s w

ith

a S

eri

ou

s M

en

tal

Illn

es

s (

SM

I) P

roje

cte

d i

n H

ea

lth

In

su

ran

ce

Exc

ha

ng

e*

• F

em

ale

• N

on-H

ispanic

White o

r H

ispanic

• C

olle

ge G

raduate

* P

opu

lation w

ith incom

e fro

m 1

33%

to 3

99%

of

the F

edera

l P

overt

y L

evel and u

nin

sure

d

Na

tio

na

l

Flo

rid

a

F

em

ale

6

0%

6

2%

A

ge

18

-34

5

7%

5

3%

R

ac

e/E

thn

icit

y

N

on

-His

pa

nic

White

68

%

64

%

N

on

-His

pa

nic

Bla

ck

10

%

12

%

O

the

r 5

%

3%

H

isp

an

ic

17

%

21

%

E

du

ca

tio

n

<

Hig

h S

ch

oo

l 1

8%

1

4%

H

igh

Sch

oo

l G

rad

ua

te

38

%

38

%

C

olle

ge

44

%

47

%

Sourc

es: 2008 –

2010 N

ational S

urv

ey o

n D

rug U

se a

nd H

ealth (

Revis

ed M

arc

h 2

012)

2

010 A

merican C

om

munity S

urv

ey

12

Mo

st

co

mm

on

ch

ara

cte

risti

cs o

f

pers

on

s w

ith

SM

I in

exch

an

ge

po

pu

lati

on

in

Flo

rid

a is

:

26

Table 7 Characteristics of Persons with Serious Mental Illness in Medicaid Expansion

Population and Health Insurance Exchange Population (2010)

State

Female Male 18-34 35-64

Non-

Hispanic

White

Non-

Hispanic

Black Other Hispanic < HS

HS

Graduate College

36 64 54 46 72 23 1 4 27 40 33

42 58 58 42 74 18 2 6 19 42 38

40 60 53 47 65 2 30 3 17 40 43

40 60 54 46 69 2 25 4 12 37 50

41 59 56 44 59 3 10 28 27 35 38

38 62 55 45 66 3 7 24 18 35 47

36 63 53 47 78 14 2 6 24 44 32

37 63 55 45 84 9 2 5 16 42 41

40 60 51 49 45 6 11 38 34 30 36

39 61 57 43 43 4 12 41 25 30 45

40 60 55 45 73 4 4 19 22 37 41

38 62 59 41 77 3 3 17 14 35 51

59 41 53 47 67 12 7 14 22 37 40

57 43 57 43 65 9 6 20 18 42 40

48 52 56 44 64 25 2 10 30 41 29

44 56 57 43 76 11 3 10 20 42 38

39 61 54 46 43 42 4 12 19 34 47

47 53 69 31 37 50 1 11 13 29 58

39 61 49 51 62 18 3 18 24 40 37

38 62 53 47 64 12 3 21 14 38 47

38 62 54 46 59 28 3 10 26 40 34

39 61 58 42 62 23 4 10 18 40 43

44 56 46 54 49 2 46 4 15 40 46

44 56 54 46 57 0 38 5 8 39 53

37 63 54 46 89 1 3 8 20 41 40

37 63 59 41 89 1 2 8 14 38 48

39 61 51 49 60 19 5 16 24 37 39

41 59 59 41 66 12 4 18 16 38 46

38 62 56 44 85 9 1 5 23 41 37

39 61 57 43 88 6 1 4 16 43 41

38 62 57 43 87 4 3 7 21 35 44

43 57 61 39 92 2 2 5 12 37 51

38 62 57 43 81 6 4 9 22 37 41

39 61 57 43 82 5 3 10 15 37 48

39 61 52 48 89 7 2 3 22 44 34

38 62 56 44 92 4 1 3 13 48 39

35 65 52 48 60 34 2 3 26 42 32

39 61 55 45 68 25 2 5 17 44 39

39 61 49 51 95 1 4 0 8 49 49

43 57 50 50 99 0 1 0 9 46 46

42 58 53 47 54 30 5 11 25 37 38

40 60 58 42 52 25 6 17 22 38 40

47 53 57 43 72 9 7 13 20 40 40

47 53 58 42 77 8 5 10 12 41 47

43 57 52 48 81 13 2 4 16 40 43

41 59 56 44 87 9 1 3 10 40 51

41 59 61 39 75 11 7 7 18 34 48

42 58 60 40 86 5 5 5 10 38 52

37 63 54 46 61 36 1 3 24 39 36

39 61 57 43 67 28 2 3 18 38 44

38 62 53 47 83 12 2 3 21 41 38

37 63 56 44 87 9 2 2 14 43 43

35 65 47 53 90 0 8 1 13 43 43

40 60 49 51 88 0 10 1 8 43 49

34 66 58 42 82 5 3 10 20 38 42

42 58 62 38 84 4 2 10 15 39 46

35 65 53 47 65 8 7 21 26 36 38

39 61 59 41 63 6 8 23 19 38 42

35 65 45 55 95 1 3 1 11 45 44

41 59 53 47 96 1 2 2 8 49 43

40 60 48 52 53 14 9 23 21 44 36

41 59 57 43 53 12 8 27 16 42 42

Arizona

California

Hawaii

Nevada

Alaska

Idaho

Maine

Gender Age Race/Ethnicity Education

Connecticut

Massachusetts

New Hampshire

New Jersey

District of Columbia

Alabama

Florida

Georgia

Maryland

Delaware

Kentucky

Mississippi

Illinois

Indiana

Michigan

Minnesota

Iowa

Arkansas

Louisiana

Kansas

Missouri

Nebraska

Colorado

Montana

27

Table 7 Characteristics of Persons with Serious Mental Illness in Medicaid Expansion


State


Non-

Hispanic

White

Non-

Hispanic

Black Other Hispanic < HS

HS

Graduate College

38 62 55 45 40 2 22 36 32 34 34

38 62 54 46 52 1 17 30 17 36 47

41 59 54 46 55 15 10 19 26 36 38

43 57 58 42 57 13 10 20 18 36 46

38 62 53 47 66 19 3 11 26 36 38

38 62 54 46 72 17 3 8 17 37 46

36 64 55 45 77 3 19 2 8 40 52

46 54 57 43 90 2 7 1 10 36 54

41 59 50 50 85 12 1 3 20 42 37

39 61 55 45 88 8 1 2 13 45 42

36 64 55 45 77 6 9 8 21 42 38

40 60 58 42 81 5 7 7 14 43 43

39 61 55 45 85 2 4 10 21 33 46

39 61 55 45 86 1 4 9 14 33 53

53 57 51 49 78 14 3 5 19 46 36

39 61 58 42 84 8 3 5 12 46 42

47 53 55 45 74 9 3 13 26 36 38

49 61 59 41 76 3 5 17 19 37 44

37 63 51 49 65 28 1 7 25 39 36

39 61 54 46 72 20 2 6 16 43 41

38 62 56 44 70 2 26 2 17 36 47

40 60 54 46 84 3 13 1 10 37 54

40 60 50 50 80 13 1 6 24 46 30

41 59 55 45 82 12 2 4 16 47 38

35 65 55 45 47 12 4 37 33 35 32

38 62 58 42 51 9 4 36 23 36 42

39 61 62 38 79 1 5 14 21 36 43

38 62 63 37 83 1 4 13 18 35 47

42 58 45 55 98 0 2 0 13 45 42

49 51 57 43 98 0 2 1 7 52 41

35 65 52 48 70 18 4 7 25 36 39

37 63 57 43 64 18 6 12 18 42 39

38 62 57 43 77 3 8 13 23 35 41

42 58 59 41 80 3 7 9 15 35 50

36 64 54 46 95 3 1 1 18 46 36

37 63 54 46 97 2 0 1 11 51 38

47 53 57 43 81 8 4 7 19 45 36

43 57 56 44 84 5 4 8 14 42 43

33 67 57 43 87 0 7 6 10 41 49

42 58 60 40 92 0 2 6 9 40 51



Utah

Wyoming

Oregon

Washington

Rhode Island

Vermont

New York

West Virginia

Virginia

Pennsylvania

North Carolina

South Carolina

Tennessee

Ohio

Medicaid Expansion Population Percentage

Health Insurance Exchange Percentage

Texas

Wisconsin

New Mexico

Oklahoma

North Dakota

South Dakota

28

Characteristics of Uninsured People with Serious Mental Illness Eligible for

Coverage in the New Medicaid Expansion Population

General Findings

Age

Age 18-34 (Highest State Percentage) – 62% in Utah; 61% in Minnesota

Age 35-64 (Highest State Percentage) – 55% in New Hampshire; 54% in Hawaii

Race/Ethnicity

White

Highest State Percentage – 98% in Vermont; 95% in West Virginia and Maine

Lowest State Percentage – 40% in New Mexico; 45% in California

Black

Highest State Percentage – 36% in Mississippi; 34% in Louisiana; 28% in South Carolina

Lowest State Percentage – 1% in New Hampshire and Maine

Hispanic

Highest State Percentage – 38% in California; 37% in Texas; 36% in New Mexico

Lowest State Percentage – 0% in Maine; 1% in West Virginia

Other (e.g., Asian-Pacific)

Highest State Percentage – 46% in Hawaii; 30% in Alaska; 26% in South Dakota

Nearly 2 in 3 uninsured people in Utah, as well as Minnesota, with a

serious mental illness who are eligible for coverage in the new

Medicaid Expansion program are between the ages of 18-34.

Over one-third of the uninsured population with a serious mental illness in the states of Mississippi and Louisiana are

Black residents, and eligible for health insurance coverage under the new Medicaid Expansion program.

29

Over one-third of the uninsured population with a serious mental

illness in the states of California, Texas and New Mexico are

Hispanic residents, and are eligible for health insurance coverage

under the new Medicaid Expansion program.

Education

< HS

Highest State Percentage – 38% in California; 33% in Texas; 32% in New Mexico;

30% in Delaware

Lowest State Percentage – 8% in Maine and South Dakota; 10% in Wyoming

HS Graduate

Highest State Percentage – 49% in Maine; 45% in New Hampshire

Lowest State Percentage – 30% in California; 34% in Minnesota and new Mexico

College

Highest State Percentage – 52% in North Dakota; 49% in Maine

Lowest State Percentage – 29% in Delaware; 30% in Tennessee

Over one-third of the uninsured population with a serious mental illness in the states of California and

Texas have less than a high-school education, and are eligible for the health insurance coverage under

the new Medicaid Expansion program.

Less than one-third of the uninsured population with a serious mental illness in the states of

California, Minnesota, and New Mexico have only a high-school education, and are eligible for health

insurance coverage under the new Medicaid Expansion program.

Less than one-third of the uninsured population with a serious mental illness in the states of Delaware

and Tennessee have a college education, and are eligible for health insurance coverage under the new

Medicaid Expansion program.

*****

Almost the entire uninsured

population with a serious mental

illness in the states of Vermont

and West Virginia are White

residents, and are eligible for

health insurance coverage under

the new Medicaid Expansion

program.

Major Finding: The majority of uninsured people with a serious mental

illness have at least a high school education, are white females, between

the ages of 18-34 – and are eligible for health insurance coverage under the

new Medicaid Expansion program.

30

Characteristics of Uninsured People with Serious Mental Illness Eligible for

Coverage in the Health Insurance Exchange Population

General Findings

Age

Age 18-34 (Highest State Percentage) – 63% in Utah; 60% in Wyoming & Minnesota

Age 35-64 (Highest State Percentage) – 51% in Montana; 50% in Maine

Race/Ethnicity

White

Highest State Percentage – 99% in Maine; 98% in Vermont; 97% in West Virginia

Lowest State Percentage – 37% in District of Columbia; 43% in

California

Black

Highest State Percentage – 50% in District of Columbia

Lowest State Percentage – 0% in Montana, Vermont, Wyoming and

Hawaii

Hispanic

Highest State Percentage – 41% in California; 36% in Texas

Lowest State Percentage – 0% in Maine; 1% in Vermont, West

Virginia, Montana, North Dakota, and South Dakota


Highest State Percentage – 38% in Hawaii; 25% in Alaska

Almost the entire

uninsured population

with a serious mental

illness in the states of

Maine, Vermont, and

West Virginia are

White residents, and

are eligible for health

insurance coverage

under the Health

Insurance Exchange

program.

Almost two-third of uninsured people in Utah, Wyoming, and Minnesota, with a serious mental illness who are eligible for coverage in the Health

Insurance Exchange program are between the ages of 18-34.

31

Almost one-fourth of the uninsured population with a serious mental illness in the states of California and Texas

have less than a high-school education, and are eligible for health insurance coverage under the Health Insurance

Exchange program.

Over one-half of the uninsured population with a serious mental illness in the states of Vermont and West

Virginia are high school graduates, and are eligible for health insurance coverage under the Health Insurance

Exchange program.

Over one-half of the uninsured population with a serious mental illness in the District of Columbia and the states

of North Dakota and South Dakota who have a college education are eligible for health insurance coverage under

the Health Insurance Exchange program.

One-half of the uninsured population with a serious mental illness in the District of Columbia

are Black residents, and eligible for health insurance coverage under the Health Insurance

Exchange program

Education

< HS

Highest State Percentage – 25% in California; 23% in Texas

Lowest State Percentage – 7% in Vermont; 8% in Montana and New Hampshire

HS Graduate

Highest State Percentage – 52% in Vermont; 51% in West Virginia

Lowest State Percentage – 30% in California; 29% in District of Columbia

College

Highest State Percentage – 58% in District of Columbia; 54% in North Dakota and South Dakota

Lowest State Percentage – 38% in Delaware, West Virginia, Alabama, and Tennessee

*****

Major Finding: The majority of uninsured people with a serious mental

illness have less than a high school education, are white females, between

the ages of 18-34 – and are eligible for health insurance coverage under the

Health Insurance Exchange program.

32

Ch

ara

cte

risti

cs o

f 18-6

4 Y

ear-

Old

s w

ith

a S

ub

sta

nce U

se

Dis

ord

er

(SU

D)

Pro

jec

ted

in

Me

dic

aid

Exp

an

sio

n P

op

ula

tio

n*

• M

ale

• N

on-H

ispanic

White o

r H

ispanic

* P

opu

lation w

ith incom

e less than 1

39%

of

the F

edera

l P

overt

y L

evel and u

nin

sure

d

Na

tio

na

l

Flo

rid

a

M

ale

7

5%

7

6%

A

ge

18

-34

6

3%

5

8%

R

ac

e/E

thn

icit

y

N

on

-His

pa

nic

White

51

%

45

%

N

on

-His

pa

nic

Bla

ck

20

%

26

%

O

the

r 4

%

2%

H

isp

an

ic

25

%

27

%

E

du

ca

tio

n

<

Hig

h S

ch

oo

l 3

7%

3

4%

H

igh

Sch

oo

l G

rad

ua

te

32

%

34

%

C

olle

ge

31

%

31

%

Sourc

es: 2008 –

2010 N

ational S

urv

ey o

n D

rug U

se a

nd H

ealth (

Revis

ed M

arc

h 2

012)

2

010 A

merican C

om

munity S

urv

ey

11

Mo

st

co

mm

on

ch

ara

cte

risti

cs o

f

pers

on

s w

ith

SU

D in

Med

icaid

exp

an

sio

n p

op

ula

tio

n i

n F

lori

da i

s:

33

Ch

ara

cte

risti

cs o

f 1

8-6

4 Y

ear-

Old

s w

ith

a S

ub

sta

nce U

se

Dis

ord

er

(SU

D)

Pro

jecte

d in

Hea

lth

In

su

ran

ce

Exc

ha

ng

e*

• M

ale

• 18-3

4 y

ears

old

• N

on-H

ispanic

White o

r H

ispanic

* P

opu

lation w

ith incom

e fro

m 1

33%

to 3

99%

of

the F

edera

l P

overt

y L

evel and u

nin

sure

d

Na

tio

na

l

Flo

rid

a

M

ale

7

3%

7

2%

A

ge

18

-34

6

9%

6

6%

R

ac

e/E

thn

icit

y

N

on

-His

pa

nic

White

52

%

46

%

N

on

-His

pa

nic

Bla

ck

14

%

17

%

O

the

r 5

%

3%

H

isp

an

ic

29

%

34

%

E

du

ca

tio

n

<

Hig

h S

ch

oo

l 2

6%

2

2%

H

igh

Sch

oo

l G

rad

ua

te

38

%

39

%

C

olle

ge

36

%

39

%

Sourc

es: 2008 –

2010 N

ational S

urv

ey o

n D

rug U

se a

nd H

ealth (

Revis

ed M

arc

h 2

012)

2

010 A

merican C

om

munity S

urv

ey

13

Mo

st

co

mm

on

ch

ara

cte

risti

cs o

f

pers

on

s w

ith

SU

D in

exch

an

ge

po

pu

lati

on

in

Flo

rid

a is

:

34

Table 8 Characteristics of Persons with Substance Use Disorder in Medicaid Expansion


State


Non-

Hispanic

White

Non-

Hispanic

Black Other Hispanic < HS HS Graduate College

27 73 63 37 56 36 1 7 39 34 27

25 75 70 30 60 27 2 11 28 42 31

24 76 63 37 62 4 28 6 25 37 38

26 74 67 33 61 3 28 9 19 39 42

23 77 65 35 44 5 7 43 39 30 31

28 72 68 32 49 4 7 41 27 35 38

26 74 63 37 65 23 1 10 35 38 27

29 71 68 32 74 15 2 9 24 43 33

23 77 61 39 30 8 8 54 46 25 29

27 73 70 30 27 5 9 59 35 29 35

24 76 65 35 58 7 3 32 33 33 35

28 72 71 39 61 4 3 31 22 36 42

23 77 63 37 52 19 5 24 33 33 34

24 76 69 31 48 12 6 34 27 41 32

18 82 65 35 48 36 1 15 42 34 24

24 76 70 30 61 17 3 18 29 41 30

19 81 63 37 28 54 2 16 29 30 41

21 79 79 21 24 59 1 16 20 31 49

24 76 58 42 45 26 2 27 34 34 31

28 72 66 34 46 17 3 34 22 39 39

28 72 71 29 47 32 4 17 26 40 34

25 75 64 36 42 40 2 16 38 34 28

21 79 56 44 47 3 43 7 23 36 41

24 76 33 67 49 0 40 10 12 42 46

26 74 64 36 80 2 2 15 29 36 35

29 71 71 29 80 1 2 17 21 39 40

24 76 60 40 44 28 4 24 35 32 33

26 74 71 29 49 17 4 31 24 39 37

25 75 65 35 74 16 1 9 33 35 31

27 73 69 31 79 11 1 9 23 43 33

25 75 66 34 78 8 2 12 31 31 38

24 76 73 27 85 3 2 10 18 39 43

25 75 66 34 70 11 3 16 32 33 36

28 72 69 31 70 8 3 20 22 38 40

24 76 62 38 82 12 1 5 33 38 29

28 72 69 31 86 7 1 6 19 48 32

27 73 62 38 44 50 2 5 37 36 26

28 72 68 32 53 36 2 8 25 44 31

24 76 58 42 94 1 4 1 13 46 41

25 75 64 36 98 0 1 1 13 48 39

22 78 66 34 38 42 4 16 36 32 32

27 73 70 30 36 32 5 27 31 37 32

19 81 66 34 59 14 5 22 30 36 35

22 78 71 29 64 12 5 19 18 43 39

22 78 61 39 70 22 2 7 25 37 39

26 74 69 31 78 14 2 6 15 42 43

23 77 70 30 64 18 6 13 27 31 43

25 75 72 28 77 8 5 9 16 40 44

26 74 64 36 44 52 1 4 35 34 31

27 73 70 30 52 40 2 5 26 38 35

25 75 62 38 72 21 1 6 32 36 33

29 71 69 31 78 15 2 5 21 44 35

28 72 57 43 89 0 8 3 21 40 39

27 73 63 37 85 1 12 2 12 45 42

28 72 67 33 71 9 2 18 30 34 37

25 75 74 26 72 6 2 19 22 40 38

27 73 62 38 50 12 5 33 37 31 32

28 72 71 29 47 8 7 38 28 38 34

27 73 55 45 93 2 3 3 18 42 40

25 75 66 34 92 1 2 5 13 51 36

24 76 58 42 38 20 7 35 31 39 31

26 74 69 31 36 15 7 42 24 42 35


Connecticut

Maine

Massachusetts

New Jersey

New Hampshire


Delaware

Maryland

Alabama

Florida

Georgia

Kentucky

Mississippi

Illinois

Indiana

Michigan

Minnesota

Iowa

Arkansas

Louisiana

Kansas

Missouri

Nebraska

Colorado

Montana

Arizona

California

Hawaii

Nevada

Alaska

Idaho

35

Table 8 Characteristics of Persons with Substance Use Disorder in Medicaid Expansion


State


Non-

Hispanic

White

Non-

Hispanic

Black Other Hispanic < HS HS Graduate College

25 75 65 35 28 3 16 53 44 29 28

29 71 67 33 36 1 15 48 25 37 38

23 77 64 36 41 23 8 29 37 31 32

24 76 71 29 41 17 9 33 27 36 37

25 75 63 37 50 29 3 18 38 31 32

28 72 66 34 57 24 3 15 25 38 37

23 73 65 35 73 5 18 4 13 38 49

22 78 70 30 87 3 9 2 15 38 46

23 77 60 40 74 20 1 5 30 38 32

27 73 68 32 80 14 1 5 19 46 35

26 74 65 35 68 10 8 14 30 37 33

26 74 70 30 71 7 8 14 21 44 35

24 76 64 36 76 3 3 18 31 30 39

27 73 67 33 77 2 4 17 21 34 45

21 79 61 39 65 23 3 9 28 41 31

27 73 70 30 73 13 3 10 19 47 34

19 81 65 35 60 15 3 23 37 31 32

27 73 71 29 61 4 5 30 28 37 35

26 74 61 39 48 41 1 10 37 33 30

28 72 67 33 58 29 2 11 23 43 34

25 75 65 35 68 3 24 4 26 32 42

26 74 67 33 79 5 15 1 15 39 46

24 76 60 40 67 22 1 10 34 40 26

26 74 68 32 71 19 2 8 23 47 31

28 72 65 35 31 16 2 51 45 29 26

28 72 70 30 33 11 3 53 32 35 33

24 76 71 29 68 2 5 25 31 31 37

28 72 75 25 70 1 4 25 26 35 39

22 78 55 45 97 1 2 1 20 41 38

20 80 69 31 97 0 2 1 11 54 35

28 72 61 39 56 29 3 12 37 31 33

29 72 70 30 49 25 5 21 27 42 31

25 75 67 33 66 5 6 22 34 31 35

25 75 71 39 69 4 8 18 22 36 42

26 74 63 37 91 6 1 3 27 41 32

29 71 67 33 94 3 1 2 17 52 32

19 81 66 34 70 15 3 12 28 40 32

25 75 69 31 73 8 4 16 21 43 36

29 71 66 34 81 0 6 12 15 39 45

25 75 72 28 86 0 2 12 15 42 43


Race/Ethnicity Education

Vermont

Rhode Island

New York

Pennsylvania

Virginia

West Virginia

North Carolina

South Carolina

Tennessee

Ohio

Health Insurance Exchange Percentage

Texas

Wisconsin

New Mexico

Oklahoma

North Dakota

South Dakota

Utah

Medicaid Expansion Population Percentage

Wyoming

Oregon

Washington

Gender Age

36

Nearly 2 in 3 uninsured people in Georgia, as well as Minnesota, with a

Substance Use Disorder who are eligible for coverage in the new Medicaid

Expansion program are between the ages of 18-34.

Characteristics of Uninsured People with Substance Use Disorder Eligible for

Coverage in the New Medicaid Expansion Population

General Findings

Age

Age 18-34 (Highest State Percentage) – 71% in Georgia and Utah; 70% in Minnesota

Age 35-64 (Highest State Percentage) – 45% in New Hampshire and Vermont; 44% in Hawaii

Race/Ethnicity

White

Highest State Percentage – 97% in Vermont; 94% in Maine

Lowest State Percentage – 28% in District of Columbia and New Mexico; 38% in New Jersey

and Maryland

Black

Highest State Percentage – 54% in District of Columbia; 52% in Mississippi

Lowest State Percentage – 0% in Montana and Wyoming; 1% in Maine and Vermont

Hispanic

Highest State Percentage –54% in California; 53% in New Mexico; 35% in New Jersey

Lowest State Percentage – 1% in Maine and Vermont; 3% in West Virginia and

New Hampshire


Highest State Percentage – 43% in Hawaii; 28% in Alaska; 24% in South Dakota

Over one-half of the uninsured population with substance use disorder in the states of Washington

and Mississippi are Black residents, and eligible for health insurance coverage under the new

Medicaid Expansion program.

37

Almost the entire uninsured population with substance use disorder in the states of Vermont and

Maine are White residents, and are eligible for health insurance coverage under the new Medicaid

Expansion program.

Education

< HS

Highest State Percentage – 46% in California; 45% in Texas; 44% in

Louisiana

Lowest State Percentage – 13% in Maine and North Dakota; 15% in

Wyoming

HS Graduate

Highest State Percentage – 46% in Maine; 42% in New Hampshire

Lowest State Percentage – 25% in California; 29% in New Mexico and

Texas

College

Highest State Percentage – 49% in North Dakota.; 43% in Minnesota

Lowest State Percentage – 24% in Delaware; 26% in Tennessee, Louisiana, and Texas

Over one-third of the uninsured population with substance use disorder in the states of California,

Texas, and Louisiana have less than a high-school education, and are eligible for health insurance

coverage under the new Medicaid Expansion program.

Less than one-third of the uninsured population with substance use disorder in the states of

California, Texas, and New Mexico have only a high-school education, and are eligible for health

insurance coverage under the new Medicaid Expansion program.

Almost one-half of the uninsured population with substance use disorder in the states of North

Dakota and Minnesota have a college education, and are eligible for health insurance coverage under

the new Medicaid Expansion program.

*****

Over one-half of the uninsured population with substance use disorder in the states of California and New Mexico are Hispanic residents, and are eligible for health insurance coverage under the new Medicaid Expansion program.

Major Finding: The majority of uninsured people with substance use

disorder have less than a high school education, are white males, between

the ages of 18-34 – and are eligible for health insurance coverage

under the new Medicaid Expansion program.

38

Characteristics of Uninsured People with Substance Use Disorder Eligible for

Coverage in the Health Insurance Exchange Population

General Findings

Age

Age 18-34 (Highest State Percentage) – 75% in Utah; 74% in Nebraska ; 73% in Iowa

Age 35-64 (Highest State Percentage) – 67% in Hawaii; 39% in Washington

Nearly 3 in 4 uninsured people in Utah, Nebraska, and Iowa with a substance use disorder who are

eligible for coverage in the Health Insurance Exchange program are between the ages of 18-34.

Race/Ethnicity

White

Highest State Percentage – 98% in Maine; 97% in Vermont; 94% in West Virginia

Lowest State Percentage – 24% in District of Columbia; 27% in California

Black

Highest State Percentage – 59% in District of Columbia; 40% in

Georgia and Mississippi

Lowest State Percentage – 0% in Montana and Wyoming; 1% in Maine

and Vermont

Hispanic

Highest State Percentage –54% in California; 53% in New Mexico;

35% in New Jersey

Lowest State Percentage – 0% in Maine, Vermont, Wyoming and

Hawaii; 1% in Idaho and New Mexico


Highest State Percentage – 40% in Hawaii; 28% in Alaska

Almost the entire uninsured population with substance use disorder in the states of Maine, Vermont,

and West Virginia are White residents, and are eligible for health insurance coverage under the Health

Insurance Exchange program

Over one-half of the

uninsured population with

substance use disorder in

the states of California and

New Mexico are Hispanic

residents, and are eligible

for health insurance

coverage under the Health

Insurance Exchange

program.

39

Over one-half of the uninsured population with substance use

disorder in the District of Columbia are Black residents, and eligible

for health insurance coverage under the Health Insurance Exchange

program.

Education

< HS

Highest State Percentage – 38% in Georgia; 35% in California;

32% in Texas

Lowest State Percentage – 11% in Vermont; 12% in Montana

HS Graduate

Highest State Percentage – 54% in Vermont; 52% in

West Virginia

Lowest State Percentage – 29% in California; 31% in


College

Highest State Percentage – 46% Hawaii and South Dakota;

45% in Oregon

Lowest State Percentage – 30% in Delaware; 31% in

Tennessee

*****

Major Finding: The majority of uninsured people with substance use

disorder have at least a high school education, are white males,

between the ages of 18-34 – and are eligible for health insurance

coverage under the Health Insurance Exchange program.

Over one-half the uninsured

population with substance

use disorder in the states of

Vermont and West Virginia

have only a high-school

education, and are eligible

for health insurance


Insurance Exchange

program.

Almost one-half of the


substance use disorder in the

states of Hawaii, South

Dakota, and Oregon have a

college education, and are

eligible for health insurance


Insurance Exchange program

Over one-third of the


substance use disorder in the

states of Georgia, California,

and Texas have less than a

high-school education, and

are eligible for health

insurance coverage under

the Health Insurance

Exchange program.

40

Table 9

State With a Serious Mental Illness With a Substance Use Disorder

Connecticut 6,023 14,320

Maine 2,099 4,755

Massachusetts 4,464 14,439

New Hampshire 1,455 4,482

Rhode Island 1,869 5,685

Vermont 716 1,260

TOTAL 16,626 44,941

New Jersey 7,489 19,362

New York 15,781 60,320

TOTAL 42,481 131,568

District of Columbia 752 3,825

Delaware 1,830 1,727

Maryland 2,346 19,932

Pennsylvania 16,133 57,889

Virginia 17,922 41,370

West Virginia 8,468 13,397

TOTAL 47,451 138,140

Alanbama 2,589 23,204

Florida 59,504 103,364

Georgia 17,908 70,659

Kentucky 16,500 27,150

Mississippi 14,434 16,091

North Carolina 13,082 53,996

South Carolina 20,826 41,736

Tennessee 14,956 47,867

TOTAL 97,706 257,499

Illinios 18,510 54,848

Indiana 38,122 54,599

Michigan 22,764 52,121

Mennisota 15,423 16,128

Ohio 40,034 71,851

Wisconsin 12,506 18,659

TOTAL 147,359 268,206

Arkansas 12,623 17,045

Louisiana 14,671 44,442

New Mexico 4,768 10,026

Oklahoma 12,613 28,587

Texas 75,253 162,798

TOTAL 119,928 262,898

Iowa 6,258 9,781

Kansas 5,661 12,904

Missouri 11,081 24,285

Nebraska 4,289 9,364

TOTAL 147,217 319,232

Colorado 6,852 21,537

Montana 2,348 7,490

North Dakota 849 3,190

South Dakota 1,214 4,698

Utah 13,191 8,723

Wyoming 1,233 1,844

TOTAL 25,687 47,482

Arizona 17,293 54,847

California 64,199 148,966

Hawaii 607 3,076

Nevada 4,474 18,710

TOTAL 112,260 273,081

Alaska 669 3,180

Idaho 7,091 14,090

Oregon 13,416 25,110

Washington 14,641 53,350

TOTAL 148,077 368,811

Number of Uninsured People 18-34 Years of Age with Income Below the FPL, 2010

41

[SECTION V] 1. EXPECTED UTILIZATION RATE OF NEWLY

INSURED POPULATIONS

2. ILLUSTRATION OF USING DATA

Tab

le 1

0

Stat

e

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

2011

%

2012

Pro

ject

ed

%

Ala

bam

a14

.218

.97.

710

.25.

47.

21.

31.

77.

29.

711

.813

.64.

15.

3

Ala

ska

6.6

8.8

3.9

5.2

2.7

3.6

†N/A

†N/A

3.8

5.1

3.9

4.5

2.2

2.9

Ari

zon

a5.

77.

62.

22.

94.

35.

7†N

/A†N

/A2

2.7

4.4

5.1

†N/A

†N/A

Ark

ansa

s10

.714

.25.

26.

91.

52.

00.

60.

85.

16.

910

.011

.51.

11.

4

Cal

ifo

rnia

4.3

5.7

2.9

3.9

3.6

4.8

0.5

0.7

2.5

3.4

2.7

3.1

2.2

2.9

Co

lora

do

68.

04.

76.

32.

53.

3†N

/A†N

/A4.

66.

25.

46.

22.

33.

0

Co

nn

ecti

cut

8.8

11.7

6.6

8.8

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

6.3

7.2

†N/A

†N/A

Del

awar

e5.

37.

04.

96.

54

5.3

†N/A

†N/A

4.9

6.6

†N/A

†N/A

†N/A

†N/A

Dis

tric

t o

f C

olu

mb

ia3.

64.

82.

63.

50.

60.

8†N

/A†N

/A†N

/A†N

/A1.

72.

0†N

/A†N

/A

Flo

rid

a7.

910

.54.

35.

73.

85.

11.

11.

43.

85.

16.

77.

72

2.6

Geo

rgia

8.5

11.3

5.5

7.3

†N/A

†N/A

†N/A

†N/A

5.5

7.4

7.2

8.3

†N/A

†N/A

Haw

aii

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

Idah

o17

.222

.911

.214

.97.

510

.0†N

/A†N

/A11

.215

.114

.616

.84.

55.

9

Illin

ois

6.9

9.2

4.5

6.0

2.8

3.7

1.6

2.1

3.8

5.1

4.6

5.3

1.8

2.3

Ind

ian

a22

.329

.710

.213

.66.

48.

53.

95.

18.

311

.218

.020

.72.

83.

6

Iow

a11

.515

.36.

58.

63.

34.

4†N

/A†N

/A6.

38.

59.

711

.22.

43.

1

Kan

sas

10.5

14.0

5.8

7.7

1.6

2.1

†N/A

†N/A

5.6

7.6

9.5

10.9

†N/A

†N/A

Ken

tuck

y11

.315

.05.

47.

24.

76.

30.

81.

04.

76.

310

.512

.13.

14.

0

Lou

isia

na

8.6

11.4

5.1

6.8

2.7

3.6

1.2

1.6

4.4

5.9

6.8

7.8

22.

6

Mai

ne

7.3

9.7

2.2

2.9

†N/A

†N/A

†N/A

†N/A

1.9

2.6

6.6

7.6

†N/A

†N/A

Mar

ylan

d4.

66.

14.

66.

1†N

/A†N

/A†N

/A†N

/A2.

63.

53.

84.

4†N

/A†N

/A

Mas

sach

use

tts

13.6

18.1

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

†N/A

8.8

10.1

†N/A

†N/A

Mic

hig

an9.

412

.54.

96.

54.

45.

91.

11.

44.

66.

28.

19.

33.

54.

6

Min

nes

ota

1114

.67.

610

.12.

33.

1†N

/A†N

/A6.

68.

99.

010

.42.

33.

0

Mis

siss

ipp

i9.

312

.44.

15.

51.

31.

7†N

/A†N

/A4.

15.

59.

010

.4†N

/A†N

/A

Mis

sou

ri16

.221

.56.

38.

44.

76.

31.

31.

75.

47.

314

.416

.64.

76.

1

Mo

nta

na

11.2

14.9

3.5

4.7

3.7

4.9

1.3

1.7

2.8

3.8

9.5

10.9

3.1

4.0

Neb

rask

a14

.419

.25.

57.

31.

92.

5†N

/A†N

/A5.

47.

311

.613

.3†N

/A†N

/A

Nev

ada

9.2

12.2

3.7

4.9

2.2

2.9

†N/A

†N/A

3.7

5.0

7.9

9.1

1.2

1.6

New

Ham

psh

ire

7.5

10.0

5.9

7.8

6.7

8.9

†N/A

†N/A

5.9

8.0

4.5

5.2

6.7

8.7

New

Jer

sey

4.3

5.7

4.1

5.5

†N/A

†N/A

†N/A

†N/A

3.8

5.1

3.7

4.3

†N/A

†N/A

New

Mex

ico

7.9

10.5

4.9

6.5

6.8

9.0

1.2

1.6

4.3

5.8

6.7

7.7

3.9

5.1

New

Yo

rk6.

78.

94.

35.

73.

34.

41.

11.

44

5.4

5.5

6.3

33.

9

No

rth

Car

olin

a8.

311

.04.

56.

02.

53.

30.

91.

24

5.4

8.0

9.2

22.

6

No

rth

Dak

ota

7.4

9.8

4.3

5.7

1.7

2.3

†N/A

†N/A

4.3

5.8

4.8

5.5

1.7

2.2

Oh

io16

.922

.511

.114

.85.

87.

71

1.3

10.4

14.0

15.0

17.3

5.3

6.9

Okl

aho

ma

9.6

12.8

4.1

5.5

4.2

5.6

†N/A

†N/A

3.9

5.3

8.8

10.1

2.8

3.6

Ore

gon

15.4

20.5

9.8

13.0

4.8

6.4

†N/A

†N/A

9.8

13.2

8.0

9.2

4.4

5.7

Pe

nn

sylv

ania

11.4

15.2

7.4

9.8

4.7

6.3

1.8

2.3

6.2

8.4

7.8

9.0

3.9

5.1

Rh

od

e Is

lan

d7.

19.

44.

96.

57.

29.

6†N

/A†N

/A3.

54.

74.

85.

56.

99.

0

Sou

th C

aro

lina

14.4

19.2

5.2

6.9

4.7

6.3

1.4

1.8

56.

814

.116

.24

5.2

Sou

th D

ako

ta19

.525

.99.

913

.22.

43.

23.

44.

48.

110

.917

.620

.2†N

/A†N

/A

Ten

nes

see

10.3

13.7

5.4

7.2

1.8

2.4

†N/A

†N/A

5.2

7.0

9.4

10.8

†N/A

†N/A

Texa

s7.

49.

83.

34.

42.

22.

90.

70.

93.

14.

26.

17.

01.

21.

6

Uta

h11

.515

.36.

18.

13.

14.

1†N

/A†N

/A6.

18.

210

.812

.41.

11.

4

Ver

mo

nt

10.5

14.0

79.

35.

87.

7†N

/A†N

/A7

9.5

5.1

5.9

†N/A

†N/A

Vir

gin

ia12

.516

.68.

611

.41.

31.

7†N

/A†N

/A7.

710

.410

.111

.6†N

/A†N

/A

Was

hin

gto

n10

.914

.56.

68.

84.

76.

3†N

/A†N

/A6.

28.

48.

910

.24.

15.

3

Wes

t V

irgi

nia

19.2

25.5

6.9

9.2

4.5

6.0

0.6

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con

sin

9.5

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bst

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ear

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ho

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insu

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amil

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13

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by

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dic

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me

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t

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den

ote

s in

suff

icie

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sam

ple

siz

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4 fo

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or

and

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min

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r) a

nd

was

su

pp

ress

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cco

rdin

g to

SA

MH

SA g

uid

elin

es.

Sou

rce:

Nat

ion

al S

urv

ey o

n D

rug

Use

an

d H

ealt

h, 2

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2011

An

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or

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Tab

le 1

1

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e

2011

%

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ject

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sey

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Sou

rce:

Nat

ion

al S

urv

ey o

n D

rug

Use

an

d H

ealt

h, 2

008-

2011

†N/A

den

ote

s in

suff

icie

nt

sam

ple

siz

e (<

4 fo

r th

e n

um

erat

or

and

<3

0 fo

r th

e d

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min

ato

r) a

nd

was

su

pp

ress

ed a

cco

rdin

g to

SA

MH

SA g

uid

elin

es.

Ab

bre

viat

ion

s: M

H, m

enta

l hea

lth

; SA

, su

bst

ance

ab

use

Re

ceip

t o

f M

en

tal H

eal

th a

nd

Su

bst

ance

Use

Tre

atm

en

t in

Pas

t Y

ear

Am

on

g A

du

lts

Age

d 1

8-6

4 Y

ear

s W

ho

Are

Un

insu

red

an

d H

ave

An

nu

al F

amil

y In

com

e B

etw

ee

n 1

39

% a

nd

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9%

of

Fed

era

l Po

vert

y Le

vel,

by

Stat

e (

He

alth

Insu

ran

ce E

xch

ange

Eli

gib

le)

and

Pro

ject

ed

Use

wh

en

Th

ese

Ind

ivid

ual

s B

eco

me

Insu

red

An

y P

resc

rip

tio

n M

edic

ati

on

fo

r

MH

An

y Sp

ecia

lty

SA F

acili

ty

Trea

tmen

tA

ny

MH

Tre

atm

ent

An

y In

pat

ien

t o

r O

utp

atie

nt

MH

Trea

tmen

tA

ny

SA T

reat

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MH

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43

Illustration of Using Service Data

How many newly insured people in Michigan will seek treatment with a

psychiatric medication?

1) Michigan population, uninsured, 18-64, <139% FPL

527,439 (American Community Survey)

(Data from Table 1, page 12)

2) Percent receiving a psychiatric Rx in Michigan who are uninsured, 18-64 years, <139% FPL

9.3%

(Data from Table 10, page 42)

3) Number of people of receiving a psychiatric Rx in Michigan who are uninsured, 18-64 years,

<139% FPL

9.3% x 527,439 = 49,051

44

[SECTION VI] 1. METHODS FOR ESTIMATING COUNTY–LEVEL

BEHAVIORAL HEALTH SERVICE USE

Methods for Estimating County-Level Behavioral Health Service Use

For large states and states that organize their behavioral health systems within county governments, determining the need for and use of mental health and substance abuse services at the county level may be particularly important. For example, California consists of 58 counties with considerable variation in structure and capacity from one county to another. Thus, insurance expansions may have very different implications for service planning in different counties. At this time, however, the availability of accurate county-level prevalence and utilization estimates is limited by the relatively small samples sizes captured in national surveys of behavioral health, such as NSDUH. In addition, although one can create synthetic estimates by projecting state-level estimates to counties by adjusting for demographic differences, the accuracy of the resulting estimates cannot be determined and may be poor. Thus, to develop county-level estimates, SAMHSA recommends that states use state-level utilization data for the particular sub-population of interest and assume that the utilization rates apply to the population within the county. The following is an example of the development of county-level estimates for enrollment in the Medicaid Expansion under the Affordable Care Act in 2014, using Alameda County, California:

1. Use the 2011 American Community Survey to determine that in Alameda County, California there are approximately 201,203 individuals aged 18–64 years who are less than 139 percent of FPL, of which 69,128 are uninsured.

2. Determine the prevalence rates. According to the state-level NSDUH estimates for California, the prevalence rate for SMI, SPD, and SUD among adults aged 18–64 years who are uninsured and have annual family incomes less than 139 percent of FPL is approximately 5.0 ,11.2 and 9.7 percent, respectively. (Data from Table 1, Table 2, and Table 3)

3. Multiply 69,128 by the prevalence rates to determine the number of individuals with SMI, SPD, and SUD in Alameda County who are likely to enroll in the Medicaid Expansion. Note that although the prevalence rates are not the same as utilization rates, they may be useful as an indicator of “need” and potentially “unmet need”:

o SMI: 5.0% x 69,128 = 3,456 Individuals o SPD: 11.2% x 69,128 = 7,742 Individuals o SUD: 9.7% x 69,128 = 6,705 Individuals

4. Next, examine current utilization rates among the same population. According to NSDUH

estimates, the utilization rates for receipt of mental health services among adults aged 18–64 years who are uninsured and have annual family incomes less than 139 percent of FPL are projected to be 2012 (Data from Table 10):

o Any mental health (MH) treatment use: 5.7% o Any inpatient MH treatment: 0.7% o Any outpatient MH treatment: 3.4% o Any prescription for MH medication: 3.1%

45

5. Calculate the number of individuals who are newly enrolled and who may use mental health services in Alameda County, California during the course of a year:

o Any MH treatment: 5.7% x 69,128 = 3,940 Individuals o Any inpatient MH treatment: 0.7% x 69,128 = 483 Individuals o Any outpatient MH treatment: 3.4% x 69,128 = 2,350 Individuals o Any prescription for MH medication: 3.1% x 69,128 = 2,142 Individuals

6. Adjust the utilization rates by assuming any induction factors. As described above, a reasonable

assumption is that once people become insured, the probability of hospital admission will increase by 30 percent, of using outpatient care by 35 percent, and of using prescription drugs by 15 percent.1 We assume that any mental health care will increase by 25 percent, based on the data reviewed above showing that overall costs increased by 25 percent and because it is in between the low and high increases among various MH services. A range of estimates can be created by using alternative assumptions.

7. Recalculate the number of individuals who are newly enrolled and who may use mental health services in Alameda County, California during the course of a year using the induction factor:

o Any MH treatment: 1.25 x 3,940 = 4,925 Individuals o Any inpatient MH treatment: 1.30 x 483 = 628 Individuals o Any outpatient MH treatment: 1.35 x 2,350 = 3,172 Individuals o Any prescription for MH medication: 1.15 x 2,142 = 2,463 Individuals

8. Calculate the increase in mental health service use during the course of a year (Step 7 minus

Step 5): o Any MH treatment: 985 Individuals o Any inpatient MH treatment: 145 Individuals o Any outpatient MH treatment: 822 Individuals o Any prescription for MH medication: 321 Individuals

1. Finkelstein A, Taubman S, Wright B, et al. The Oregon Health Insurance Experiment: Evidence from the First Year. National Bureau of Economic Research Working Paper No. 17190, July 2011. Available at: http://www.nber.org/papers/w17190.

How Many Newly insured individuals in Alameda County, CA will seek treatment with a psychiatric medication?

1) Alameda County, CA who are uninsured, 18-64 years, <139% FPL

69,128 (American Community Survey 2) Psychiatric Rx users in CA who are uninsured, 18-64 years, <139% FPL

3.1% 3) Number of psychiatric Rx users

3.1% x 69,128 = 2,142

46

http://www.nber.org/papers/w17190

For more information please contact: Robert W. Glover, Ph.D. Narges Maududi, B.S. [email protected] [email protected]

National Association of State Mental Health Program Directors 66 Canal Center Plaza, Suite 302

Alexandria, VA 22314 Phone: 703-739-9333 www.nasmhpd.org

mailto:[email protected]

mailto:[email protected]

nasmhpd resource management guide: impacts of affordable

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