Wilson explores the impact of lapses in Medicaid coverage for people with severe mental illness, substance use disorders

—by Paul M. Kubek

Research has demonstrated that gaps in insurance coverage are associated with a number of negative consequences for both individuals and healthcare systems. Large numbers of people who transition in and out of insurance programs (a process called "churning") tend to drive up the costs of administering the insurance. People who churn tend to use expensive emergency and inpatient services instead of less expensive and more clinically appropriate outpatient care. In addition, they tend not to access preventative services and other services that may help them manage health conditions, especially chronic ones.

Not much is known about churning among people with severe mental illnesses, so Amy Blank Wilson, PhD, assistant professor of social work at the Mandel School of Applied Social Sciences, will be exploring how transitioning on and off Medicaid insurance might impact their access to the community-based services that are so essential for their health, well-being, and recovery.

Wilson is principal investigator of a new study, titled "Medicaid Enrollment Volatility among People with Serious Mental Illness and Dual Diagnoses: Exploring the Nature of Churning and Its Impact on Service Utilization." It is funded by the Ohio Department of Mental Health. The study is taking place in Cuyahoga County, Ohio, whose population of 1.28 million makes it one of the largest service areas in the state's public mental-health system. Wilson has been studying the experiences of people with severe mental illness for over 10 years.


In this study, Wilson and her research team are conducting a secondary-data analysis of behavioral-healthcare claims data that have been submitted to Ohio's Medicaid system through the Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Cuyahoga County by community-based organizations that provide mental-health and addiction-treatment services. The claims data represent adult men and women between the ages of 18 and 61 who have been diagnosed with a Schizophrenia spectrum disorder or major affective disorder.

The study's retrospective cohort design is combining and comparing Medicaid eligibility and service utilization patterns of each consumer over a four-year period, from fiscal years 2007 to 2010. The study aims to achieve several research objectives:

  • Identify Medicaid eligibility patterns of people with severe mental disorders
  • Identify the characteristics of people with multiple transitions on and off Medicaid during this time period (churning)
  • Compare the characteristics and eligibility patterns of "churners" with individuals who maintain more stable patterns of Medicaid coverage
  • Explore how churning impacts utilization of behavioral-health services
  • Explore if any characteristics define churners as a group distinct from those who experience only one disruption in Medicaid coverage or those who maintain continuous coverage

Wilson explains that results of this study may help policymakers and service providers design interventions that quickly identify individuals who are at-risk of losing their insurance, assist them with staying enrolled, and help them access services which enable them to manage symptoms, prevent relapse and hospitalization, and enhance their quality of life. 

Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University, a partnership between the Mandel School of Applied Social Sciences and Department of Psychiatry at the Case School of Medicine.