INSOMNIA IN STATE MEDICAID ADMINISTRATIVE CLAIMS: MISSED OPPORTUNITY FOR IMPLEMENTATION AND DISSEMINATION?

Document Type

Conference Proceeding

Publication Date

5-1-2024

Publication Title

Sleep

Abstract

Introduction: It is well-established that insomnia is more prevalent in under-resourced communities, which is further exacerbated by the limited access to treatment. To address this health need, essential health care services are made available by the government to those without the financial resources to purchase them (e.g., Medicaid). However, it is unclear if services for insomnia are available and accessible even within these programs. This study aimed to estimate the prevalence and patterns of diagnosis of insomnia among recipients of a state Medicaid program. Methods: We accessed Medicaid administrative data through the state data warehouse to identify beneficiaries who had a service between 11/1/2019 and 10/31/2023 with a diagnosis code for sleep problems. We calculated the prevalence of sleep-related diagnoses out of the total number of beneficiaries with enrollment during the study period. Results: Of 3.7 million beneficiaries, 310,092 had at least one service during the study period with a sleep problem diagnosis code, for a prevalence of 8.25%. Their most common sleep problem diagnosis codes were G4700-INSOMNIA, UNSPECIFIED (5.65%), F5101-PRIMARY INSOMNIA (1.14%), G479- SLEEP DISORDER, UNSPECIFIED (0.82%), and F5102- ADJUSTMENT INSOMNIA (0.27%). Among beneficiaries with at least one sleep problem diagnosis code, 55.10% had diagnosis codes in the past 6 months indicating a significant mental health condition, substance use disorder, or neurologic condition; and 6.80% had a diagnosis of shift work disorder, free running type and/or restless leg syndrome in the past 48 months. Conclusion: Other health care administrative datasets have estimated the prevalence of insomnia diagnoses at ∼30-35%; in comparison, these findings suggest that insomnia may be severely underdiagnosed and treated among Medicaid beneficiaries. This is a significant missed opportunity for implementation and dissemination of insomnia treatment for low-income adults with Medicaid coverage.

Volume

47

First Page

A158

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