The Affordable Care Act’s offer to the states to make poor, childless adults who are not disabled eligible for Medicaid, although accompanied by a substantial subsidy, isn’t playing well in some states. But there is one state where similar provisions have been in effect since 2001: Arizona.
“Overall, the findings from Arizona suggest that as states expand coverage to adults under reform, meeting their health care needs will likely require a broad package of benefits, specialized treatment services, and care and disease management programs for those with significant and complex mental and physical health conditions …” says a white paper by the Kaiser Family Foundation. States will also need to come up with strategies to connect these new beneficiaries with a medical home or other primary care provider so that they get the preventive care they need.
The paper, “Health Care Use and Chronic Conditions Among Childless Adult Medicaid Enrollees in Arizona (http://kff.org/medicaid/upload/8310.pdf),” states that there were about 17 million nonelderly uninsured adults who had income at or below 133 percent of the federal poverty level in 2010 — the new cutoff for Medicaid. “These uninsured adults account for 37 percent of all the uninsured in the United States, and nearly seven in ten of them are adults without dependent children.”
The study looks at utilization patterns of 48,857 childless adults, 92,118 parents, and 31,340 disabled adults, and includes an analysis of adults who were high users of health care services in Arizona in 2007.
It finds that mental illness is the most prevalent condition in this cohort, affecting 70 percent of high users of inpatient hospital care, 64 percent of high users of emergency room care, and 60 percent of high users of physician visits. “These findings suggest that care management strategies such as medical homes, chronic disease management programs, and targeted health outcomes may all be important for providing care to childless adults covered by the expansion.”