A Retrospective Claims Analysis of the Utilization of Services by Medicaid-Enrolled Adults Seeking Treatment for Major Depressive Disorder (MDD) in Washington State

Abstract

Washington State has a shortage of mental health providers and estimates show that the state is only meeting 40% of the need for mental health services for the Medicaid population (The Kaiser Commission on Medicaid and the Uninsured, 2014). This study evaluates whether Medicaid-enrolled adults in Washington State receive adequate treatment for Major Depressive Disorder (MDD) when compared to recommended treatment guidelines. This study used publicly available claims data from September 1, 2014, through September 30, 2015 to conduct an observational retrospective cohort study where a diagnosis of MDD was the eligibility criterion to be included in the study (N=11,463). Evaluation of adequate treatment for MDD was separated into three groups that include minimally adequate psychotherapy, minimally adequate pharmacotherapy, and inadequate treatment. In this study 30% of subjects received adequate psychotherapy (95% confidence interval, 29.1% to 30.9%), less than 1% of subjects received adequate pharmacotherapy (95% confidence interval, 0.0004% to 0.002%), and 70% of subjects received inadequate treatment for their diagnoses of MDD (95% confidence interval, 69.1% to 70.8%). This study found statistically significant associations between inadequate depression treatment and age, race/ethnicity, location of initial diagnosis, and depression subtype. These study results are consistent with previous research and confirm that Washington is not immune to the disparities that exist in the mental health services provided to Medicaid-enrolled adults across the United States.