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Expecting Value: Monitoring Medicaid Provision of Substance Use Treatment

A quick check of the numbers will show how well your Medicaid health insurance plan is identifying and treating individuals with substance use disorders. Many Medicaid health plans use a standard report card, the National Committee on Quality Assurance (NCQA) Health Plan Employer Data and Information Set. There are three required alcohol and drug treatment measures: rates of identifying substance use problems; rates of starting treatment; and rates of engaging patients in continuing care. Your health plans should be at least average, and many states are setting stretch goals for their Medicaid plans such as the following:

Identification of alcohol and other drug problems at least 3 percent of all covered beneficiaries
Initiation into treatment at least 66 percent of all patients identified
Engagement in treatment at least 50 percent of all patients who start alcohol treatment

Unfortunately, average HEDIS results for Medicaid plans remain significantly below these goals. Listed below are the mean 2008 HEDIS scores results Medicaid HMOs reporting results to the National Committee on Quality Assurance. If your health insurance plan is below average, your health plan design or the way it is being managed needs improvement.

Identification of alcohol and other drug problems 2.3%
Initiation into treatment 45.6%
Engagement in treatment 14.4%

These results only refer to Medicaid HMOs that report HEDIS results to the National Committee on Quality Assurance. Many individuals receiving Medicaid services are enrolled in plans that do not currently report to NCQA. While 66 percent of Medicaid beneficiaries were enrolled in a private health plan, only 25% of them were covered by a plan that reported HEDIS data to NCQA in 2008. In contrast, over 44 percent of individuals with private, commercial health insurance were enrolled in plans that report to NCQA.