Authors
Onur Baser, Heidi C Waters, Nehir Yapar, Gabriela Samayoa, Xue Han, Deborah Freedman, Lauren Isenman, Rashmi Patel
Published in
The American journal of managed care. Volume 32. Issue 6. Pages e198-e204. Jun 01, 2026. Epub Jun 01, 2026.
Abstract
Health care resource utilization (HCRU) and cost among Medicaid patients with serious mental illness (SMI) were compared in states with high and low reimbursement for psychiatric services.
Retrospective cohort study.
Using 2021-2023 Kythera Labs Medicaid data, the 20 most frequently billed procedures by psychiatrists were identified. We selected states with the top 20% and bottom 20% mean reimbursement. The SMI population had 1 or more medical claims for SMI during the identification period and continuous enrollment for 1 year pre- and post diagnosis. The effect of reimbursement rates on health outcomes was estimated, controlling for patient-level and fixed-state characteristics.
The high-reimbursement-rate cohort (n = 99,024) was 5% less likely to have psychiatric-specific inpatient and outpatient visits and 23% less likely to have psychiatric-specific emergency department (ED) visits than the low-reimbursement cohort (n = 154,437). The high-reimbursement cohort was less likely to have inpatient and ED visits and demonstrated 24% lower overall costs and 19% lower psychiatric-specific costs annually.
Higher Medicaid reimbursement rates for psychiatric services were associated with reduced HCRU and costs. Although this observed association may not imply causality, it could reflect beneficial behavioral changes (eg, improved provider participation and care continuity) or unintended mechanisms such as increased utilization review that may restrict access.
PMID:
42335251
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 1
- Comments 0