The cost of Medicaid-covered services provided to disabled adults with neurologic disorders: implications for managed care.

OBJECTIVES

To estimate the mean annual per capita cost of care provided to disabled adult Medicaid recipients with neurologic conditions and to compare mean annual costs for disabled adult Medicaid recipients with those of nondisabled adult Medicaid recipients.

STUDY DESIGN

Medicaid eligibility and claims files for all of calendar year 1993 were obtained from the state of Pennsylvania. Mean annual per capita costs are mean Medicaid expenditures on claims filed for Medicaid-covered services and pharmaceuticals provided in 1993 to full-year eligible Medicaid recipients.

PATIENTS AND METHODS

Disabled adults aged 18 to 64 years with one or more of several neurologic conditions were identified from medical diagnoses (International Classification of Diseases, 9th Revision codes) reported on claims. A comparison group of nondisabled adults was chosen from the Medicaid Eligibility File. Annual costs were estimated for a wide range of specific services as well as for 3 broad service categories.

RESULTS

There were large differences between disabled and nondisabled adults in mean annual per capita costs of acute care and other medical services ($4142 vs $1451), rehabilitation and support services ($3835 vs $235), and pharmaceuticals ($1116 vs $382). Mean costs also differed significantly among persons with different neurologic conditions. The mean annual per capita cost for all services was $5368 for adults with epilepsy and $19,356 for those with a spinal cord injury. All differences are statistically significant (P < .001).

CONCLUSIONS

States may want to separately capitate rehabilitation and support services given the large differences in the magnitude and relative distribution of costs for disabled and nondisabled Medicaid recipients.