Sept 11, 2014

State Trends - Parity and Disparity

Parity

Or Disparity

8,019,763 Enrolled

National Rate59.20% - Eligible Individuals Were Insured

Enrolled the Least….

45,390 People33.64% Eligible

Enrolled the Most….

1,405,102 People74.47% Eligible

Wisconsin Could Save $206 Million (2013-2015)….If It had Expanded Medicaid by April 1, 2014.

It Can Save $315 Million (2015 – 2017) If It ChoosesTo Expand

State Benchmarks of Essential Health Benefits – Marketplace

22 States Have Quantitative Limits on Mental Health Services

UtahMost Limiting… 8

OutpatientVisits Per Plan Year

Combined WithSubstance Abuse

30InpatientVisits Per Plan Year

Standardized across States

Tracked Yearly Adult and

Youth

Mental Health Data

Who’s In Need?• Any Mental Illness• Serious Mental

Illness• Dually Diagnosed

with Substance Use• Children with

Serious Emotional Disturbance

Do They Get Help?• Who Needed But Did Not

Receive Treatment• Who is Insured • Provider Shortages• State Expenditures

How Do They Get Help?

• Community Utilization• Residential and Inpatient

Treatment • Treatment at School• Peer Support Services

Do They Get Better?

• Employment• Housing• Community Inclusion

Example Data Sets

• The National Survey on Drug Use and Health

• The Uniform Reporting System• National Survey of Children’s

Health• National Provider

Identification

Lowest Rate of Any Mental Illness

DC

New Jersey 14.66Illinois 15.86Nevada 16.05

Connecticut 16.71North Carolina 16.84

Texas 16.86Florida 16.87

Minnesota 17.18North Dakota 17.21

Massachusetts 17.38Hawaii 17.48Virginia 17.50

Highest Rate of Any Mental Illness

DC

Arkansas 19.81Michigan 19.81Indiana 19.87Maine 20.05

Tennessee 20.25Mississippi 20.27

Idaho 20.58Washington 20.77

Oregon 20.89West Virginia 21.38

Oklahoma 21.88Utah 22.35

RankingPeople with Any

Mental Illness

- Census Data: Utah

1,968,099 X .2235439,870

individuals

1 New Jersey 14.662 Illinois 15.863 Nevada 16.054 Connecticut 16.715 North Carolina 16.846 Texas 16.867 Florida 16.878 Minnesota 17.189 North Dakota 17.21

10 Massachusetts 17.3811 Hawaii 17.4812 Virginia 17.5013 California 17.6814 South Dakota 17.7715 Nebraska 17.8916 Maryland 17.9317 Wisconsin 17.9818 Pennsylvania 17.9919 Colorado 18.1220 Kansas 18.2021 Delaware 18.2622 Iowa 18.4023 New Hampshire 18.5324 New York 18.6125 Rhode Island 18.80

26 Arizona 18.8327 Montana 18.9228 Alaska 18.9429 Georgia 18.9930 Missouri 18.9931 Louisiana 19.2832 Alabama 19.3433 Vermont 19.3934 DC 19.4435 Kentucky 19.4736 South Carolina 19.5637 New Mexico 19.5938 Wyoming 19.6039 Ohio 19.6440 Arkansas 19.8141 Michigan 19.8142 Indiana 19.8743 Maine 20.0544 Tennessee 20.2545 Mississippi 20.2746 Idaho 20.5847 Washington 20.7748 Oregon 20.8949 West Virginia 21.3850 Oklahoma 21.8851 Utah 22.35

Lowest Rate Uninsured Adults withAny Mental Illness

DC

North Carolina 2.56Connecticut 2.72

Nevada 2.74Georgia 2.83Florida 2.91Illinois 2.95Texas 2.97

California 3.12New Jersey 3.20

North Dakota 3.20Vermont 3.23

South Dakota 3.26

Highest Rate Uninsured Adults withAny Mental Illness

DC

DC 5.22Tennessee 5.29

Alaska 5.34Washington 5.34

Indiana 5.58Oregon 5.77

West Virginia 5.79Arizona 5.87

Ohio 5.95Idaho 6.13Utah 6.14

Alabama 6.86

Ranking People with Any

Mental Illnesswho are

Uninsured

Nevada2,094,509

X .027457,389 vs.

45,390 enrolled Jan - April

1 North Carolina 2.562 Connecticut 2.723 Nevada 2.744 Georgia 2.835 Florida 2.916 Illinois 2.957 Texas 2.978 California 3.129 New Jersey 3.20

10 North Dakota 3.2011 Vermont 3.2312 South Dakota 3.2613 South Carolina 3.3714 Kentucky 3.4115 Maine 3.5916 Rhode Island 3.6817 Minnesota 3.7018 New York 3.7419 Kansas 3.7520 Delaware 3.8721 Pennsylvania 3.8822 Missouri 3.9123 Maryland 3.9424 Colorado 4.0325 Virginia 4.06

26 Iowa 4.0827 Wisconsin 4.1528 Nebraska 4.2629 Montana 4.5030 Wyoming 4.5631 Hawaii 4.5832 Oklahoma 4.6533 Mississippi 4.6734 Louisiana 4.7235 New Hampshire 4.7636 Michigan 4.8837 Massachusetts 4.9238 Arkansas 5.0339 New Mexico 5.1540 DC 5.2241 Tennessee 5.2942 Alaska 5.3443 Washington 5.3444 Indiana 5.5845 Oregon 5.7746 West Virginia 5.7947 Arizona 5.8748 Ohio 5.9549 Idaho 6.1350 Utah 6.1451 Alabama 6.86

How They Compare…8 States OverlapAny Mental Illness Any Mental Illness/Uninsured

New Jersey 14.66Illinois 15.86Nevada 16.05

Connecticut 16.71North Carolina 16.84

Texas 16.86Florida 16.87

Minnesota 17.18North Dakota 17.21

Massachusetts 17.38Hawaii 17.48Virginia 17.50

Lowest Rate of Children Who Needed but Didn’t Receive Services

North Dakota 13.7Vermont 22.1

Maine 22.2West Virginia 26.4

Kansas 27.8Minnesota 28.5Nebraska 29.3

Pennsylvania 31.2Michigan 32.5Wyoming 32.7Arkansas 33.2Delaware 33.5

DC

Bottom States – Rate of Children Who Needed but Didn’t Receive Services

Idaho 43.7Illinois 44.9

North Carolina 45.7Washington 46.1

Alabama 46.3Georgia 47

Mississippi 47.1Virginia 47.4

South Carolina 49.9Nevada 50.7

Utah 50.9Louisiana 59.6

DC

1 North Dakota 13.72 Vermont 22.13 Maine 22.24 West Virginia 26.45 Kansas 27.86 Minnesota 28.57 Nebraska 29.38 Pennsylvania 31.29 Michigan 32.5

10 Wyoming 32.711 Arkansas 33.212 Delaware 33.513 Iowa 33.714 New Hampshire 33.715 Ohio 33.716 Rhode Island 3417 Oregon 34.218 Kentucky 34.319 Wisconsin 34.620 Connecticut 3521 Colorado 35.122 Massachusetts 35.123 New York 35.624 South Dakota 36.425 Missouri 36.5

26 Alaska 36.827 California 37.328 Oklahoma 39.329 Tennessee 39.830 Montana 40.131 Arizona 40.332 Texas 40.533 Maryland 40.834 DC 41.135 Indiana 41.836 New Mexico 4237 Florida 42.338 Hawaii 42.439 New Jersey 42.440 Idaho 43.741 Illinois 44.942 North Carolina 45.743 Washington 46.144 Alabama 46.345 Georgia 4746 Mississippi 47.147 Virginia 47.448 South Carolina 49.949 Nevada 50.750 Utah 50.951 Louisiana 59.6

Ranking for Children with

“Unmet Need”

Health Issue Asked About*

% Amon

g CSHCN

Health Issue Asked About

% Amon

g CSHCN Learning Disability 27.2 Speech Problems 15.6

ADD/ADHD 32.2 Tourette Syndrome 0.2 Depression 8.5 Asthma 30.2 Anxiety Problems 13.4 Diabetes 1.4 Autism, Asperger’s, ASD 8.0 Epilepsy 3.1 Behavioral Problems 13.6 Hearing Problems 4.2 Developmental Delay 14.7 Vision Problems 3.2

Intellectual Disability 4.8 Bone, Joint or Muscle Problems 7.7

Cerebral Palsy 1.0 Brain Injury 1.1 *Condition prevalence in 2011/12 was asked using two questions: prevalence of conditions

ever or currently. Only current prevalence is reported here.

Children Who Needed MH Treatment/Did Not Receive Defined by CDC as: Children with Special Healthcare Needs

% Among

% Among

Hawaii 2.55North Dakota 2.98

Iowa 3.46New Jersey 3.55

Nevada 3.59Maine 3.66

Nebraska 3.73Wisconsin 3.75

Florida 3.76Tennessee 3.94

Texas 3.97South Dakota 3.97

Top States – Rate of Adults Who Needed but Didn’t Receive Services

DC

DC

Highest Rate of Adults Who Needed but Didn’t Receive Services

Oregon 6.17Rhode Island 6.18

Alabama 6.24Indiana 6.25Kansas 6.45

Arkansas 6.52Utah 6.68

New Hampshire 6.76Washington 6.83

Montana 6.91DC 7.30

Arizona 7.99

Ranking Adults with

“Unmet Need”

26 South Carolina 5.0427 Wyoming 5.0528 Ohio 5.1829 Mississippi 5.2330 Alaska 5.3731 Minnesota 5.4432 Missouri 5.4833 Virginia 5.5734 Vermont 5.6735 Michigan 5.7536 New Mexico 5.7537 West Virginia 5.8138 Colorado 5.9539 Idaho 5.9640 Oregon 6.1741 Rhode Island 6.1842 Alabama 6.2443 Indiana 6.2544 Kansas 6.4545 Arkansas 6.5246 Utah 6.6847 New Hampshire 6.7648 Washington 6.8349 Montana 6.9150 DC 7.3051 Arizona 7.99

1 Hawaii 2.552 North Dakota 2.983 Iowa 3.464 New Jersey 3.555 Nevada 3.596 Maine 3.667 Nebraska 3.738 Wisconsin 3.759 Florida 3.76

10 Tennessee 3.9411 Texas 3.9712 South Dakota 3.9713 Delaware 4.1314 New York 4.1715 California 4.1916 Georgia 4.3417 Illinois 4.4118 North Carolina 4.4619 Pennsylvania 4.5620 Maryland 4.6421 Kentucky 4.7222 Louisiana 4.7323 Massachusetts 4.7924 Oklahoma 4.8625 Connecticut 4.96

How They Compare…8 States OverlapHighest Uninsured/ AMI Highest “Unmet Need”

Oregon 6.17Rhode Island 6.18

Alabama 6.24Indiana 6.25Kansas 6.45

Arkansas 6.52Utah 6.68

New Hampshire 6.76Washington 6.83

Montana 6.91DC 7.30

Arizona 7.99

Florida

• SMI-3.75%. Lower CI at 3.17% Census Adult Population: 15316595

• 485,536 people with Serious Mental Illness.

• Most Recent Survey of Florida State Mental Health Agency Reported they served 319,190 individuals

• Unmet Need – 2.55%

• 575,903 people reporting Unmet Need

• Serving a significant portion of those with SMI. Still much to go, to help with Unmet Need

Highest MH Expenditure Per Capita, 2012

DC

Maine $338.24Alaska $335.36

DC $305.37Pennsylvania $295.08

New York $269.60Vermont $253.28

Connecticut $213.43New Jersey $210.58

Arizona $209.44Montana $197.89Maryland $184.62Oregon $177.80

Lowest MH Expenditure Per Capita, 2012

DC

Indiana $70.58Louisiana $65.51

Utah $64.39Nevada $59.41

South Carolina $57.07Oklahoma $56.22

Georgia $56.08Kentucky $55.07Arkansas $45.05

Texas $38.05Florida $37.28Idaho $32.54

Ranking 2012

State Mental Health

Expenditures Per Capita

1 Maine $338.242 Alaska $335.363 DC $305.374 Pennsylvania $295.085 New York $269.606 Vermont $253.287 Connecticut $213.438 New Jersey $210.589 Arizona $209.4410 Montana $197.8911 Maryland $184.6212 Oregon $177.8013 California $169.6514 Minnesota $168.1515 Iowa $143.8116 New Hampshire $136.1417 North Carolina $134.7818 Kansas $134.4919 New Mexico $131.4420 Hawaii $131.1621 Michigan $120.1022 Washington $112.9823 Wyoming $111.4824 Massachusetts $108.6225 Mississippi $106.61

26 Rhode Island $106.3527 Wisconsin $102.9028 Delaware $100.0229 Colorado $95.0130 Ohio $92.7731 Virginia $92.4832 Missouri $92.2133 Tennessee $88.8534 North Dakota $86.1735 South Dakota $85.5836 Nebraska $84.8237 West Virginia $83.8738 Alabama $76.2739 Illinois $74.8840 Indiana $70.5841 Louisiana $65.5142 Utah $64.3943 Nevada $59.4144 South Carolina $57.0745 Oklahoma $56.2246 Georgia $56.0847 Kentucky $55.0748 Arkansas $45.0549 Texas $38.0550 Florida $37.2851 Idaho $32.54

Lowest Ratio of Population to MH Provider

DC

Massachusetts 248:1DC 293:1

Vermont 329:1Maine 342:1

Rhode Island 361:1New Mexico 376:1

Oregon 410:1Oklahoma 426:1

Alaska 450:1Connecticut 455:1

New Hampshire 493:1New York 510:1

Highest Ratio of Population to MH Provider

DC

Nevada 1,015:1Ohio 1,023:1

Wisconsin 1,024:1North Dakota 1,033:1

Iowa 1,144:1Arizona 1,145:1

Mississippi 1,183:1Louisiana 1,272:1

West Virginia 1,291:1Georgia 1,440:1Texas 1,757:1

Alabama 1,827:1

RankingWorkforce Need

26 Montana 752:127 New Jersey 809:128 Pennsylvania 837:129 Idaho 839:130 Illinois 844:131 Kentucky 852:132 Kansas 861:133 South Dakota 871:134 Indiana 890:135 Florida 890:136 Missouri 947:137 Tennessee 974:138 South Carolina 995:139 Virginia 998:140 Nevada 1,015:141 Ohio 1,023:142 Wisconsin 1,024:143 North Dakota 1,033:144 Iowa 1,144:145 Arizona 1,145:146 Mississippi 1,183:147 Louisiana 1,272:148 West Virginia 1,291:149 Georgia 1,440:150 Texas 1,757:151 Alabama 1,827:1

1 Massachusetts 248:12 DC 293:13 Vermont 329:14 Maine 342:15 Rhode Island 361:16 New Mexico 376:17 Oregon 410:18 Oklahoma 426:19 Alaska 450:110 Connecticut 455:111 New Hampshire 493:112 New York 510:113 Wyoming 510:114 Washington 533:115 Nebraska 560:116 Colorado 570:117 Utah 587:118 Hawaii 597:119 California 623:120 Michigan 661:121 Maryland 666:122 Delaware 675:123 North Carolina 696:124 Arkansas 696:125 Minnesota 748:1

Highest Rate Improved Social Connectedness

DC 95.40New Jersey 94.40

Florida 86.70Mississippi 84.40Oklahoma 80.90Kentucky 79.80New York 77.80Georgia 76.70

New Mexico 76.30Kansas 75.40

North Dakota 75.40Alabama 74.70

DC

Lowest Rate Improved Social Connectedness

DC

Massachusetts 64.50Maryland 64.10

New Hampshire 64.10Wisconsin 64.10

Utah 63.60Colorado 63.40

Maine 63.10Texas 62.90Iowa 59.10

Arkansas 58.70Oregon 58.50Idaho 55.80

RankingImprovedSocial Connections

1 DC 95.402 New Jersey 94.403 Florida 86.704 Mississippi 84.405 Oklahoma 80.906 Kentucky 79.807 New York 77.808 Georgia 76.709 New Mexico 76.30

10 Kansas 75.4011 North Dakota 75.4012 Alabama 74.7013 Delaware 73.8014 Connecticut 73.7015 Wyoming 73.7016 Louisiana 73.5017 North Carolina 73.0018 West Virginia 72.9019 Nevada 72.9020 Arizona 72.1021 Hawaii 72.0022 Illinois 72.0023 Nebraska 72.0024 Michigan 71.0025 Pennsylvania 70.60

26 Rhode Island 69.8027 South Carolina 69.5028 Minnesota 69.3029 South Dakota 68.9030 Missouri 67.6031 California 67.5032 Montana 66.5033 Washington 66.5034 Virginia 66.4035 Indiana 66.0036 Vermont 66.0037 Alaska 65.9038 Tennessee 65.8039 Ohio 65.1040 Massachusetts 64.5041 Maryland 64.1042 New Hampshire 64.1043 Wisconsin 64.1044 Utah 63.6045 Colorado 63.4046 Maine 63.1047 Texas 62.9048 Iowa 59.1049 Arkansas 58.7050 Oregon 58.5051 Idaho 55.80

Putting It All Together….the Rankings

• Any Mental Illness• AMI and Uninsured• Children with Unmet

Need• Adults with Unmet

Needs• State Mental Health

Expenditures• Workforce Needs• Improved Social

Connectedness

Georgia Ranking29th4th45th

16th

46th

49th

8th

47 West Virginia48 Louisiana49 Utah50 Mississippi51 Alabama

42 Oklahoma43 Washington44 Arizona45 Indiana46 Idaho

36 Arkansas37 Kentucky38 Ohio39 New Mexico40 South Carolina41 Georgia

28 Wyoming29 Michigan30 Montana31 Delaware32 Florida33 Missouri34 Virginia35 Tennessee

20 Rhode Island21 New Hampshire22 Texas23 Illinois24 Oregon25 Nevada26 DC27 Kansas

From Last to First…

11 Nebraska12 New York13 North Carolina14 North Dakota15 Hawaii16 Wisconsin17 Alaska18 South Dakota19 Colorado

6 Pennsylvania7 Iowa8 Massachusetts9 Maryland10 New Jersey

4 California5 Minnesota

312

Vermont

Maine

Connecticut

And The Winner Is….

47 West Virginia48 Louisiana49 Utah50 Mississippi51 Alabama

42 Oklahoma43 Washington44 Arizona45 Indiana46 Idaho

36 Arkansas37 Kentucky38 Ohio39 New Mexico40 South Carolina41 Georgia

28 Wyoming29 Michigan30 Montana31 Delaware32 Florida33 Missouri34 Virginia35 Tennessee

20 Rhode Island21 New Hampshire22 Texas23 Illinois24 Oregon25 Nevada26 DC27 Kansas

From Last to First…

11 Nebraska12 New York13 North Carolina14 North Dakota15 Hawaii16 Wisconsin17 Alaska18 South Dakota19 Colorado

6 Pennsylvania7 Iowa8 Massachusetts9 Maryland10 New Jersey

4 California5 Minnesota

Next Steps?• Finish Report • Infographics and Advocacy• Track Chosen Measures

Over Time• Identify Effect of Parity • Identify Ongoing

Disparity• Input on Measures?• Yearly• State Comparison Data• Adult and Youth

Questions at End…tnguyen@mentalhealthamerica.net