Upload
dinhkien
View
218
Download
1
Embed Size (px)
Citation preview
Joel E. Miller, M.S. ED. Narges Maududi, B.S.
Iowa
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
Figu
re 3
So
urc
e: N
atio
nal
Su
rvey
on
Dru
g U
se a
nd
Hea
lth
, 20
08
-20
11
0.0
5.0
10
.0
15
.0
20
.0
25
.0
30
.0
35
.0
40
.0
45
.0
50
.0
20
.5
11
.3
5.2
18
.3
9.9
6
Prevalence Rate (%)
Iow
a 2
01
0Io
wa
20
11
Cu
rre
nt
Me
dic
aid
P
op
ula
tio
n
He
alth
In
sura
nce
Ex
chan
ge P
op
ula
tio
n
Age
s 1
8-6
4 b
y C
urr
en
t M
ed
icai
d S
tatu
s an
d E
ligib
ility
fo
r M
ed
icai
d E
xpan
sio
n o
r H
eal
th In
sura
nce
Exc
han
ges:
Ne
w Y
ork
, US
Pe
rce
nta
ge o
f U
nin
sure
d P
eo
ple
Age
s 1
8-6
4 in
Iow
a w
ith
a S
eri
ou
s M
en
tal I
llne
ss (
SMI)
El
igib
le f
or
He
alth
Insu
ran
ce in
th
e C
urr
en
t M
ed
icai
d P
rogr
am; a
nd
un
de
r th
e N
ew
Me
dic
aid
Ex
pan
sio
n P
rogr
am a
nd
Ne
w S
tate
He
alth
Insu
ran
ce E
xch
ange
in t
he
Aff
ord
able
Car
e A
ct
(20
10
vs.
20
11
)
Me
dic
aid
Ex
pan
sio
n
11
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 Iowa 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 11,000 individuals (10,978) who are uninsured in Iowa (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 7,000 (6,659) individuals who are uninsured in Iowa (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 18,000 (17,637) individuals who are uninsured in Iowa (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 and the New State Health Insurance Exchange in
the Affordable Care Act (ACA).
4. Nearly 30,000 (30,205) individuals who are uninsured in Iowa (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 48,000 (47,843) individuals who are uninsured in Iowa (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 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
-20
11
05
10
15
20
25
30
35
40
45
50
34
21
11
.3
32
.7
19
.2
13
.1
Prevalence Rate (%)
Iow
a 2
01
0Io
wa
20
11
Cu
rre
nt
Me
dic
aid
P
op
ula
tio
n
He
alth
In
sura
nce
Ex
chan
ge P
op
ula
tio
n
Age
s 1
8-6
4 b
y C
urr
en
t M
ed
icai
d S
tatu
s an
d E
ligib
ility
fo
r M
ed
icai
d E
xpan
sio
n o
r H
eal
th
Insu
ran
ce E
xch
ange
s: N
ew
Yo
rk, U
S
(20
10
vs.
20
11
Dat
a)
Pe
rce
nta
ge o
f U
nin
sure
d P
eo
ple
Age
s 1
8-6
4 in
Iow
a w
ith
Se
rio
us
Psy
cho
logi
cal D
istr
ess
(SP
D)
Elig
ible
fo
r H
eal
th In
sura
nce
in t
he
Cu
rre
nt
Me
dic
aid
Pro
gram
; an
d u
nd
er
the
Ne
w M
ed
icai
d
Exp
ansi
on
Pro
gram
an
d N
ew
Sta
te H
eal
th In
sura
nce
Exc
han
ge in
th
e A
ffo
rdab
le C
are
Act
(2
01
0 v
s. 2
01
1)
Me
dic
aid
Exp
ansi
on
P
op
ula
tio
n
14
Table 2
Eligible for Coverage under the Current Medicaid Program
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
Source: National Survey on Drug Use and Health, 2008-2011
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
New Medicaid Expansion Program and New State Health Insurance Exchange in the Affordable Care Act (ACA), and
Medicaid Expansion Population
15
Key Findings
Number of Uninsured People Ages 18-64 in Iowa 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
Coverage under the Current Medicaid Program, 2011
1. Nearly 21,500 adults (21,291) who are uninsured in Iowa (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 15,000 (14,539) adults who are uninsured in Iowa (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 State Health Insurance Exchange (online marketplace) in the Affordable Care Act
(ACA).
3. Nearly 36,000 (35,831) adults who are uninsured in Iowa (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 and the New State Health Insurance Exchange in
the Affordable Care Act (ACA).
4. Nearly 54,000 (53,973) adults who are uninsured in Iowa (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
Current State Medicaid Program already operating in the state and in place prior to the
passage of the Affordable Care Act (ACA).
5. Nearly 90,000 (89,804) adults who are uninsured in Iowa (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 and the New State Health Insurance Exchange in
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
11
.9
16
.5
13
.5
12
.9
14
.7
15
.4
Prevalence Rate (%)
Iow
a 2
01
0Io
wa
20
11
Cu
rre
nt
Me
dic
aid
P
op
ula
tio
n
He
alth
In
sura
nce
Ex
chan
ge P
op
ula
tio
n
Age
s 1
8-6
4 b
y C
urr
en
t M
ed
icai
d S
tatu
s an
d E
ligib
ility
fo
r M
ed
icai
d E
xpan
sio
n o
r H
eal
th In
sura
nce
Exc
han
ges:
Ne
w Y
ork
, US
Pe
rce
nta
ge o
f U
nin
sure
d P
eo
ple
Age
s 1
8-6
4 in
Iow
a w
ith
a S
ub
stan
ce U
se D
iso
rde
r (S
UD
)
Elig
ible
fo
r H
eal
th In
sura
nce
in t
he
Cu
rre
nt
Me
dic
aid
Pro
gram
; an
d u
nd
er
the
Ne
w M
ed
icai
d
Exp
ansi
on
Pro
gram
an
d t
he
Ne
w S
tate
He
alth
Insu
ran
ce E
xch
ange
in t
he
Aff
ord
able
Car
e A
ct
(20
10
vs.
20
11
)
Me
dic
aid
Exp
ansi
on
P
op
ula
tio
n
17
Table 3
Eligible for Coverage under the Current Medicaid Program
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
Source: National Survey on Drug Use and Health, 2008-2011
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
New Medicaid Expansion Program and New State Health Insurance Exchange in the Affordable Care Act (ACA), and
Medicaid Expansion Population
18
Key Findings
Number of Uninsured People Ages 18-64 in Iowa 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
Coverage under the Current Medicaid Program, 2011
1. Nearly 16,500 adults (16,301) who are uninsured in Iowa (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).
2. Nearly 17,500 (17,091) adults who are uninsured in Iowa (not covered by a public or
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
New State Health Insurance Exchange (online marketplace) in the Affordable Care Act
(ACA).
3. Nearly 33,500 (33,393) adults who are uninsured in Iowa (not covered by a public or
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
New Medicaid Expansion Program and the New State Health Insurance Exchange in
the Affordable Care Act (ACA).
4. Nearly 20,000 (19,641) adults who are uninsured in Iowa (not covered by a public or
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
Current State Medicaid Program already operating in the state and in place prior to the
passage of the Affordable Care Act (ACA).
5. Nearly 53,500 (53,035) adults who are uninsured in Iowa (not covered by a public or
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
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.
19
Nearly 33,000 (32,270) uninsured adults in Iowa 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 49,000 (48,572) uninsured adults in Iowa 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 49,000 uninsured adults in Iowa with a behavioral health condition represent
44 percent of the total adults 110,895 in the state who are eligible for coverage under the
New Medicaid Expansion Program.
*****
Nearly 22,000 (21,198) uninsured adults in Iowa with a mental health condition
(persons with either a serious mental illness or in serious psychological distress) are
eligible for coverage under the new State Health Insurance Exchange Program.
Nearly 39,000 (38,290) uninsured adults in Iowa with a behavioral health 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.
The 39,000 uninsured adults in Iowa with a behavioral health condition represent
35 percent of the total persons 110,986 in the state who are eligible for coverage under
the new State Health Insurance Exchange Program.
*****
Nearly 84,500 (84,179) uninsured adults in Iowa with a mental health condition
(persons with either a serious mental illness or in serious psychological distress) are
eligible for coverage under the Current State Medicaid Program.
Nearly 104,000 (103,821) uninsured adults in Iowa with a behavioral health 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 Iowa
20
The nearly 138,000 uninsured adults with a mental health condition (persons with either a serious
mental illness or in serious psychological distress) in Iowa represent (35 percent) of the 386,939
uninsured adults eligible for coverage in the state under the three health insurance programs
(Current Medicaid, New Medicaid, New Exchanges).
The nearly 191,000 uninsured adults with a behavioral health condition (people with a serious mental
illness, in serious psychological distress, or with a substance use disorder) in Iowa represent
(49 percent) of the 386,939 uninsured adults eligible for coverage in the state under the three health
insurance programs.
The 104,000 uninsured adults in Iowa with a behavioral health condition represent
63 percent of the total persons 165,058 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
• C
olle
ge 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
Iow
a
F
em
ale
6
1%
6
2%
A
ge
18
-34
5
3%
5
7%
R
ac
e/E
thn
icit
y
N
on
-His
pa
nic
White
66
%
87
%
N
on
-His
pa
nic
Bla
ck
13
%
4%
O
the
r 5
%
3%
H
isp
an
ic
16
%
7%
E
du
ca
tio
n
<
Hig
h S
ch
oo
l 2
6%
2
1%
H
igh
Sch
oo
l G
rad
ua
te
38
%
35
%
C
olle
ge
37
%
44
%
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 I
ow
a a
re:
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*
•18-3
4 y
ears
old
• N
on-H
ispanic
White
• 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
Iow
a
F
em
ale
6
0%
5
7%
A
ge
18
-34
5
7%
6
1%
R
ac
e/E
thn
icit
y
N
on
-His
pa
nic
White
68
%
92
%
N
on
-His
pa
nic
Bla
ck
10
%
2%
O
the
r 5
%
2%
H
isp
an
ic
17
%
5%
E
du
ca
tio
n
<
Hig
h S
ch
oo
l 1
8%
1
2%
H
igh
Sch
oo
l G
rad
ua
te
38
%
37
%
C
olle
ge
44
%
51
%
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
ex
ch
an
ge
po
pu
lati
on
in
Io
wa a
re:
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
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
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
Source: National Survey on Drug Use and Health, 2008-2011
Gender Age Race/Ethnicity Education
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
Other (e.g., Asian-Pacific)
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
• 18-3
4 y
ears
old
• N
on-H
ispanic
White
* 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
Iow
a
M
ale
7
5%
7
5%
A
ge
18
-34
6
3%
6
6%
R
ac
e/E
thn
icit
y
N
on
-His
pa
nic
White
51
%
78
%
N
on
-His
pa
nic
Bla
ck
20
%
8%
O
the
r 4
%
2%
H
isp
an
ic
25
%
12
%
E
du
ca
tio
n
<
Hig
h S
ch
oo
l 3
7%
3
1%
H
igh
Sch
oo
l G
rad
ua
te
32
%
31
%
C
olle
ge
31
%
38
%
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 I
ow
a a
re:
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
• C
olle
ge G
raduate
* P
op
ula
tio
n w
ith
in
co
me
fro
m 1
33
% t
o 3
99
% o
f
the F
edera
l P
overt
y L
evel and u
nin
sure
d
Na
tio
na
l
Iow
a
M
ale
7
3%
7
6%
A
ge
18
-34
6
9%
7
3%
R
ac
e/E
thn
icit
y
N
on
-His
pa
nic
White
52
%
85
%
N
on
-His
pa
nic
Bla
ck
14
%
3%
O
the
r 5
%
2%
H
isp
an
ic
29
%
10
%
E
du
ca
tio
n
<
Hig
h S
ch
oo
l 2
6%
1
8%
H
igh
Sch
oo
l G
rad
ua
te
38
%
39
%
C
olle
ge
36
%
43
%
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
Io
wa a
re:
34
Table 8 Characteristics of Persons with Substance Use Disorder 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
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
Gender Age Race/Ethnicity Education
Connecticut
Maine
Massachusetts
New Jersey
New Hampshire
District of Columbia
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
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
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
Source: National Survey on Drug Use and Health, 2008-2011
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
Other (e.g., Asian-Pacific)
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
Other (e.g., Asian-Pacific)
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
District of Columbia
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
coverage under the Health
Insurance Exchange
program.
Almost one-half of the
uninsured population with
substance use disorder in the
states of Hawaii, South
Dakota, and Oregon have a
college education, and are
eligible for health insurance
coverage under the Health
Insurance Exchange program
Over one-third of the
uninsured population with
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
0.8
6.8
9.2
18.5
21.3
3.2
4.2
Wis
con
sin
9.5
12.6
5.9
7.8
7.5
10.0
†N/A
†N/A
5.8
7.8
9.5
10.9
6.2
8.1
Wyo
min
g13
.317
.75.
37.
02.
33.
1†N
/A†N
/A5.
37.
212
.113
.91.
11.
4
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 <
13
9%
of
Fed
era
l Po
vert
y Le
vel,
by
Stat
e (
Me
dic
aid
Exp
ansi
on
Eli
gib
le)
and
Pro
ject
ed
Use
wh
en
Th
ese
Ind
ivid
ual
s B
eco
me
Insu
red
An
y Sp
ecia
lty
SA F
acili
ty
Trea
tmen
t
†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
eno
min
ato
r) a
nd
was
su
pp
ress
ed a
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
008-
2011
An
y M
H T
reat
men
tA
ny
Inp
atie
nt
or
Ou
tpat
ien
t M
H
Trea
tmen
t
An
y SA
Tre
atm
ent
An
y In
pat
ien
t M
H T
reat
men
tA
ny
Ou
tpat
ien
t M
H T
reat
men
tA
ny
Pre
scri
pti
on
Med
ica
tio
n f
or
MH
42
Tab
le 1
1
Stat
e
2011
%
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%20
11 %
2012
Pro
ject
ed
%
Ala
bam
a10
.514
.07.
39.
73.
44.
5†N
/A†N
/A7.
39.
910
.111
.62.
12.
7
Ala
ska
4.8
6.4
3.1
4.1
3.5
4.7
†N/A
†N/A
3.1
4.2
2.7
3.1
2.4
3.1
Ari
zon
a6.
99.
2†N
/A†N
/A1.
41.
9†N
/A†N
/A†N
/A†N
/A6.
97.
9†N
/A†N
/A
Ark
ansa
s19
.325
.74.
86.
42.
93.
9†N
/A†N
/A4.
86.
519
.222
.12.
02.
6
Cal
ifo
rnia
7.1
9.4
3.3
4.4
1.9
2.5
0.5
0.7
3.0
4.1
5.0
5.8
1.2
1.6
Co
lora
do
9.9
13.2
5.3
7.0
2.3
3.1
†N/A
†N/A
5.0
6.8
7.4
8.5
0.8
1.0
Co
nn
ecti
cut
8.3
11.0
0.9
1.2
3.6
4.8
†N/A
†N/A
0.9
1.2
7.3
8.4
1.7
2.2
Del
awar
e7.
810
.45.
47.
21.
62.
1†N
/A†N
/A5.
47.
36.
47.
41.
41.
8
Dis
tric
t o
f C
olu
mb
ia11
.014
.66.
78.
92.
33.
1†N
/A†N
/A†N
/A†N
/A8.
69.
9†N
/A†N
/A
Flo
rid
a7.
510
.03.
34.
42.
53.
30.
70.
93.
14.
27.
18.
21.
92.
5
Geo
rgia
2.5
3.3
2.0
2.7
2.2
2.9
†N/A
†N/A
1.7
2.3
0.9
1.0
0.7
0.9
Haw
aii
10.6
14.1
8.0
10.6
†N/A
†N/A
†N/A
†N/A
†N/A
†N/A
†N/A
†N/A
†N/A
†N/A
Idah
o16
.221
.58.
511
.35.
77.
6†N
/A†N
/A8.
511
.515
.617
.92.
02.
6
Illin
ois
8.3
11.0
3.3
4.4
1.8
2.4
0.3
0.4
3.1
4.2
6.8
7.8
1.4
1.8
Ind
ian
a9.
612
.86.
38.
42.
43.
2†N
/A†N
/A6.
38.
58.
49.
7†N
/A†N
/A
Iow
a12
.616
.86.
08.
03.
44.
5†N
/A†N
/A6.
08.
19.
310
.72.
63.
4
Kan
sas
16.5
21.9
10.8
14.4
1.9
2.5
†N/A
†N/A
10.8
14.6
12.7
14.6
0.6
0.8
Ken
tuck
y6.
99.
23.
85.
13.
44.
5†N
/A†N
/A3.
34.
56.
47.
4†N
/A†N
/A
Lou
isia
na
7.0
9.3
3.6
4.8
1.6
2.1
†N/A
†N/A
3.2
4.3
6.5
7.5
1.6
2.1
Mai
ne
10.9
14.5
5.5
7.3
3.1
4.1
†N/A
†N/A
4.2
5.7
8.5
9.8
1.2
1.6
Mar
ylan
d5.
87.
73.
64.
83.
24.
3†N
/A†N
/A3.
34.
54.
34.
93.
24.
2
Mas
sach
use
tts
13.6
18.1
7.1
9.4
†N/A
†N/A
†N/A
†N/A
6.5
8.8
13.0
15.0
†N/A
†N/A
Mic
hig
an9.
412
.54.
56.
04.
05.
31.
01.
34.
15.
57.
78.
92.
83.
6
Min
nes
ota
11.5
15.3
8.7
11.6
†N/A
†N/A
†N/A
†N/A
8.7
11.7
11.2
12.9
†N/A
†N/A
Mis
siss
ipp
i11
.515
.37.
39.
72.
43.
21.
72.
25.
87.
89.
811
.31.
41.
8
Mis
sou
ri12
.716
.94.
86.
45.
16.
8†N
/A†N
/A4.
86.
511
.913
.71.
72.
2
Mo
nta
na
14.1
18.8
3.0
4.0
4.2
5.6
†N/A
†N/A
2.9
3.9
13.3
15.3
3.9
5.1
Neb
rask
a17
.623
.48.
311
.04.
76.
3†N
/A†N
/A6.
79.
015
.017
.33.
74.
8
Nev
ada
6.1
8.1
1.4
1.9
4.8
6.4
0.5
0.7
0.9
1.2
5.1
5.9
3.4
4.4
New
Ham
psh
ire
14.6
19.4
8.3
11.0
3.1
4.1
†N/A
†N/A
8.0
10.8
11.0
12.7
3.0
3.9
New
Jer
sey
10.7
14.2
6.5
8.6
3.2
4.3
1.8
2.3
6.0
8.1
9.1
10.5
†N/A
†N/A
New
Mex
ico
7.4
9.8
4.7
6.3
4.8
6.4
†N/A
†N/A
4.7
6.3
6.1
7.0
0.8
1.0
New
Yo
rk4.
56.
03.
24.
33.
14.
10.
60.
83.
14.
23.
64.
11.
82.
3
No
rth
Car
olin
a9.
512
.63.
85.
15.
37.
0†N
/A†N
/A3.
85.
18.
09.
21.
72.
2
No
rth
Dak
ota
9.0
12.0
5.3
7.0
3.3
4.4
†N/A
†N/A
4.5
6.1
5.6
6.4
2.0
2.6
Oh
io11
.014
.66.
58.
63.
54.
70.
70.
96.
18.
28.
39.
52.
73.
5
Okl
aho
ma
12.7
16.9
3.2
4.3
3.4
4.5
†N/A
†N/A
3.2
4.3
10.3
11.8
3.2
4.2
Ore
gon
14.4
19.2
6.7
8.9
5.0
6.7
0.8
1.0
6.2
8.4
11.6
13.3
4.7
6.1
Pe
nn
sylv
ania
12.4
16.5
7.1
9.4
4.5
6.0
1.1
1.4
6.8
9.2
9.5
10.9
3.1
4.0
Rh
od
e Is
lan
d17
.222
.97.
810
.48.
110
.84.
45.
77.
39.
915
.417
.75.
97.
7
Sou
th C
aro
lina
10.4
13.8
5.1
6.8
†N/A
†N/A
1.4
1.8
5.1
6.9
9.1
10.5
†N/A
†N/A
Sou
th D
ako
ta13
.718
.21.
62.
13.
74.
9†N
/A†N
/A1.
62.
212
.714
.63.
14.
0
Ten
nes
see
12.0
16.0
3.4
4.5
3.3
4.4
†N/A
†N/A
2.4
3.2
12.0
13.8
2.6
3.4
Texa
s7.
29.
63.
34.
41.
01.
3†N
/A†N
/A2.
93.
96.
27.
10.
50.
7
Uta
h13
.518
.07.
39.
74.
66.
1†N
/A†N
/A7.
29.
79.
310
.73.
64.
7
Ver
mo
nt
12.2
16.2
7.2
9.6
1.9
2.5
†N/A
†N/A
7.2
9.7
8.7
10.0
1.4
1.8
Vir
gin
ia16
.421
.86.
99.
28.
911
.8†N
/A†N
/A6.
79.
013
.815
.98.
310
.8
Was
hin
gto
n6.
58.
63.
04.
02.
93.
9†N
/A†N
/A3.
04.
13.
74.
31.
21.
6
Wes
t V
irgi
nia
13.7
18.2
6.5
8.6
1.2
1.6
†N/A
†N/A
6.0
8.1
11.7
13.5
†N/A
†N/A
Wis
con
sin
17.8
23.7
10.0
13.3
3.3
4.4
†N/A
†N/A
9.4
12.7
16.4
18.9
2.3
3.0
Wyo
min
g13
.217
.68.
911
.83.
14.
1†N
/A†N
/A8.
811
.910
.011
.52.
53.
3
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
eno
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
39
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
men
tA
ny
Inp
atie
nt
MH
Tre
atm
ent
An
y O
utp
atie
nt
MH
Tre
atm
ent
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
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