The influence of diagnoses, race, and Medicaid enrollment on health services among the seriously mentally disabled population

Equitable access to physical health services and mental health services among the severely mentally disabled (SMD) population is a significant public health concern. This research has four aims: (1) To describe the seriously mentally disabled population of Franklin County, Ohio, receiving services from the public mental health system. (2) To describe and to compare the Medicaid enrolled seriously mentally disabled population with the non-Medicaid enrolled serious mentally disabled population with respect to race, age, sex, and psychiatric diagnoses. (3) To examine the impact of psychiatric diagnoses on physical health services utilization, mental health service utilization, and related health care costs among a cohort of individuals with serious mental disabilities enrolled for three years in Medicaid in Franklin County, Ohio. (4) To examine the impact of race on physical health service utilization, mental health service utilization, and related health care costs among a cohort of individuals with serious mental disabilities enrolled for three years in Medicaid in Franklin County, Ohio.; Analyses of aim one indicated that of the SMD population, who met the criteria for inclusion in the study 69.5% were Caucasian and 30.5% were African American. Fifty nine percent were females and 41% were males. Affective Psychoses (34%) and Schizophrenic Disorders (13%) comprised the largest diagnostic category of this population. Race was determined to influence psychiatric diagnoses. Analyses of aim two demonstrated that Medicaid status was variable and influenced by psychiatric diagnoses, age, and race.; Analyses of aim three indicated that utilization of acute care services among the SMD population was high. Conversely, services received for women's preventive health care, and dental and vision care were below recommended clinical standards. Differences in patterns of physical and mental health services were noted by psychiatric diagnoses. Analyses of aim four indicated that racial differences in psychiatric diagnoses, Medicaid and Medicare enrollment status, and the utilization of pharmaceutical agents occurred in this SMD population supporting previous research findings.