February 4, 2016

By Imaz Athar

 In this post, I’ll be explaining some research I’ve done at Pitt regarding Medicaid mental health services in Allegheny County. Read on to find out whether or not the services in our county truly serve the low-income individuals who need them the most.
What’s Medicaid?
This past July, Pennsylvania adopted the Affordable Care Act’s (ACA) Medicaid expansion to low-income adults. This was significant for a number of reasons but, before I dive into that, let me first explain what Medicaid is. Medicaid is a form of public health insurance that’s designated for low-income individuals and families. To be eligible for Medicaid, you must be a U.S. citizen or legal permanent resident under the age of 65. Among the benefits of Medicaid are that it provides insurance to low-income individuals (a group which, studies have shown, are more vulnerable to poor health) and it seeks to reduce costs of health services.
Now back to why Medicaid expansion in Pennsylvania is important. Basically, under Pennsylvania’s new ACA Medicaid program, known as HealthChoices, a larger group of low-income people are eligible for health insurance—now, anyone within 138% of the poverty level is eligible. Also, HealthChoices seeks to streamline the health system, so that it’s easier for low-income individuals to access health services. After individuals sign up for HealthChoices, they enroll in a managed care plan. The managed care plan opens recipients up to managed care organizations (MCOs) that connect patients to specific health services.
So, let’s say a Medicaid recipient in Allegheny County needs to access a mental health service. What do they do? Allegheny County’s mental health MCO, also known as Community Care Behavioral Health (CCBH), will connect the patient to a mental health service that’s covered by Medicaid.
This sounds pretty good. It seems that we have a clean system that, in theory, is easy for a Medicaid recipient to navigate. But, while Medicaid recipients can be easily connected to services, are the services adequate? In other words, do they provide quality and comprehensive treatment? Are they located in low-income areas that have high Medicaid enrollment? Do they address social determinants (such as unemployment or poverty) that can lead to poor health in low-income individuals.
The Research Project
These are all questions that I’ve wondered about—specifically how they apply to mental health services. The quality and accessibility of Medicaid mental health services is especially important, as low-income individuals are perhaps the most vulnerable to mental illness. Recently, I’ve started a research project under the University of Pittsburgh’s Department of Sociology to answer the questions that I stated above.
Allegheny County’s department of health services has plenty of information about the county’s mental health services. This list provides great information about the Medicaid mental health services that CCBH connects Medicaid recipients to. I went through this list and did some research on each mental health service. In a spreadsheet, I noted whether or not each provided the following: outpatient treatment, inpatient treatment, diagnostic service, residential services, drug/alcohol services, and services that address the social determinants of health (ie. employment services, utilities assistance).
Next, I broke up the services into 6 categories: comprehensive, treatment, residential, general health, drop-in, and ‘other.’ Here’s a quick breakdown of what each of these categories mean:
  1. Comprehensive: these services are the ‘cream of the crop’, in that they provide mental health treatment, diagnostic services, drug/alcohol services, as well as social services (ie. job training services) that target the social determinants of health—these social services are essential as stress due to unemployment and poverty is a risk factor for mental illness. Some comprehensive services also provide residential services for individuals with serious psychiatric disorders.
  2. Treatment: these services solely provide mental health treatment, including counseling or medication
  3. Residential: these services solely provide short-term and/or long-term residential services
  4. General health: these services focus on general health, rather than just mental health
  5. Drop-in: these services don’t focus tremendously on health, but rather serve as a homeless shelter, provide food, etc. Some provide health care.
  6. Other: these services solely target the social determinants of health (ie. employment or utilities services)

After I broke the services down into categories, I put pins on a map of Allegheny County to mark their location.

 

Findings

The areas with a darker shade of orange in the map above have higher Medicaid enrollment. Much of these dark-orange areas are located around Pittsburgh—this makes sense considering more low-income people live in urban areas. There are also dark-orange areas in McKeesport and Penn Hills, which also makes sense since poverty levels in these areas are relatively high.
From the map, you can see that many mental health services are located in dark-orange areas. This is incredibly encouraging because low-income areas are often underserved. Yet, in Allegheny County, it seems that many of the Medicaid mental health services are in the areas that need these services the most—areas with high Medicaid enrollment.
There’s also a wide range of mental health services in these high Medicaid areas. Take a close look at the Pittsburgh region, and you’ll see a number of treatment, residential, comprehensive, and social services. Mental health is a multifaceted issue in low-income communities; stress from unemployment or poverty can result in mental health issues, while serious psychiatric disorders such as schizophrenia are often under-addressed. The fact that a variety of services are located in these areas gives good reason to be optimistic about the quality of mental health treatment in often-underserved communities.
Nonetheless, areas such as McKeesport and McKees Rocks (area to the left of Pittsburgh on the map) lack services, even though these areas have high Medicaid enrollment. McKeesport does have have a walk-in treatment service, but it doesn’t provide comprehensive counseling, medication management, or residential services for serious psychiatric disorders. Meanwhile, the McKees Rocks area, lacks any kind of mental health service that’s covered by Medicaid. Furthermore, if you zoom out and look at the periphery of Allegheny county (ie. Ross Township, McCandless Township, and Bethel Park), Medicaid mental health services are scarce. Although Medicaid enrollment in these areas is quite low, it would be difficult for Medicaid recipients in these suburban areas to access services—they would have to make quite the trip to services located in the Pittsburgh region.
What now?
So, that’s a summary of what I’ve found so far. Again, it’s very encouraging that Medicaid mental health services are located in areas that most need them. The same can’t be said for Medicaid recipients in suburban areas. In future posts, I hope to discuss that, as well as the lack of services in McKeesport and the Mckees Rocks area, in greater length. Stay tuned!