The cost of medicaid-covered services provided to disabled adults with neurologic disorders: Implications for managed care

Objectives: To estimate the mean annual per capita, cost: of care provided to disabled adult Medicaid recipients with neurologic conditions and to com pare mean annual costs for disabled adult Medicaid recipients with those of nondisabled adult Medicaid recipients, Study Design: Medicaid eligibility and claims files for all of calendar yea r 1993 were obtained from the state of Pennsylvania. Mean annual per capita costs are mean Medicaid expenditures on claims filed for Medicaid-covered services and pharmaceuticals provided in 1993 to full-year eligible Medicai d recipients. Patients and Methods: Disabled adults aged 18 to 64 years with: one or more of several neurologic conditions were identified from medical diagnoses (I nternational Classification of Diseases, 9th Revision codes) reported on cl aims, A comparison group of nondisabled adults was chosen from the Medicaid Eligibility File, Annual costs were estimated for a:wide range of specific services as well as for 3 broad service categories. Results: There were large differences between disabled and nondisabled adul ts in mean annual per capita costs of acute care and other medical services ($4142 vs $1451), rehabilitation and support services ($3835 vs $235), and pharmaceuticals ($1116 vs $382), Mean costs also differed Significantly am ong persons with different neurologic conditions, The mean annual per capit a cost for all services was $5368 for adults with epilepsy and $19,356 for those with a spinal cord injury. All differences are statistically signific ant (P < .001). Conclusions: States may want to separately capitate rehabilitation and supp ort services given the large differences in the magnitude and relative dist ribution of costs for disabled and nondisabled Medicaid recipients.