Avoiding the cliff

In non-Medicaid expansion states, youth with SCD who are enrolled in Medicaid or CHIP face the likely loss of health insurance when they become adults. This exacerbates all of the health, financial, social, and emotional challenges that accompany transition.

Some of these youth have hospital utilization patterns that qualify them for adult SSDI coverage, though they are not likely to realize it unless state Medicaid programs are assertively and effectively promoting awareness of this possibility. Hospitals have a financial incentive to keep these young adults insured, as clear from the extent of self-pay visits (see chart below; more detail in the attached brief).

A state hospital association or other entity that collects hospital discharge data could run an algorithm on administrative data to identify individuals meeting criteria for SSDI, and could reach out to facilitate their obtaining coverage. The entity holding multiple hospitals' administrative data is better positioned to identify patients that meet the clinical definition of disability than a single hospitals, since in some areas individuals may use multiple EDs rather than always going to the same one. 

Three of four benchmarks can be assessed through discharge data. Another relates to hemoglobin levels, which necessitates lab data. This suggests an alternative approach: an app in which patients enter their own data and are notified when they appear to qualify.

The end results could be better SCD management and primary care for these young adults; lower use of the emergency department for both SCD-related and non-SCD related causes;  greater likelihood of hospital admission for care when called for; and financial support during a crucial period from which to have better chances of emerging as healthy, productive, independent adults. 

Credit goes to my colleague Angie Snyder for this strategy.