Identification of Cross-sector Service Utilization Patterns among Urban Medicaid Expansion Enrollees

Peter J. Bodurtha, Tyler Winkelman, Katherine D. Vickery, Ross Owen, Renee Van Siclen, Erik Erickson, Courtney Hougham, Mark Legler, Latasha Jennings, Nathan Shippee

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. Objective: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. Research Design: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. Measures: Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. Results: We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. Conclusions: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalMedical care
Issue number2
StatePublished - Feb 1 2019

Bibliographical note

Funding Information:
From the *Hennepin County; †Hennepin Healthcare and Hennepin Health-care Research Institute; and ‡University of Minnesota, Division of Health Policy and Management School of Public Health, Minneapolis, MN. Funded and supported from the Center for Health Care Strategies and the Rethinking Care Program: Innovations in Complex Care grant (#20141670) from the Kaiser Permanente Foundation. The authors declare no conflict of interest. Reprints: Peter J. Bodurtha, MPP, Hennepin County Center of Innovation and Excellence, 701 4th Avenue, Suite 360, Minneapolis, MN 55418. E-mail: Supplemental Digital Content is available for this article. Direct URL cita-tions appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.lww-medicalcare. com. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0025-7079/19/5702-0123

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.


  • Medicaid expansion
  • behavioral health
  • cost
  • criminal justice
  • housing
  • latent class analysis
  • social determinants of health


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