Use of Hospital-based Services among Young Adults with Behavioral Health Diagnoses Before and After Health Insurance Expansions

Young adults have high levels of behavioral health care needs and relatively low levels of health insurance coverage. Access to health insurance for young adults is rising with recent health reforms and coverage of behavioral health care is becoming more generous due to federal parity, but it is unclear whether use and financing of hospital-based care changes after expanding insurance coverage.

We evaluate the association between health insurance coverage expansions and use of hospital-based care among young adults with behavioral health diagnoses. We use hospital inpatient and emergency department data from 2003-2009 to estimate differential changes in service use among young adults with behavioral health diagnoses in Massachusetts versus other states before and after Massachusetts’ 2006 health reform.

We find that after 2006, uninsurance among 19 to 25 year olds in Massachusetts fell from 25% to 9% (P=.001), with no significant change in other states. Young adults experienced relative declines in inpatient admissions per 1000 for primary diagnoses of any behavioral health disorder (-2.0; P<.001) depression (-0.39; P=.006) and substance use disorder (-1.19; P<.001). Although emergency department visits with any behavioral health diagnosis rose after 2006, the rise was lower among young adults in Massachusetts compared to Maryland (-14.14 per 1000; P<.001). Among young adults in Massachusetts, the share of inpatient admissions and emergency department visits that were uninsured fell by 6.25 and 4.9 percentage points (P=.007 and P=.002) relative to other states.

Following large increases in insurance coverage, use of hospital based care among young adults with behavioral health diagnoses did not rise relative to other age groups or compared with other states. Expanded insurance coverage increased financial protection to young adults with behavioral health diagnoses, and to the hospitals that care for them.

 We are currently extending this work to examine whether the expansion of dependent care coverage under the ACA or the Mental Health Parity and Addiction Equity Act resulted in additional changes to inpatient or emergency department use.