State-Level Analysis of Access to Intensive Eating Disorder Care for Medicaid Beneficiaries

OBJECTIVE: Eating disorders are often underdiagnosed and untreated. Among Medicaid beneficiaries, standard outpatient care is often the only service received for eating disorders. More severe cases, however, may require more intensive services (e.g., intensive outpatient, partial hospitalization, residential, or inpatient care). Medicaid is the largest public health insurance payer, but whether Medicaid beneficiaries have access to these services and what barriers to access they face remain unclear. This study aimed to investigate the availability of intensive eating disorder services across the United States and to identify factors affecting access to these services. METHODS: A state-level database was developed by combining Medicaid claims data, National Alliance for Eating Disorders data on treatment centers, and publicly available state census information. RESULTS: Across 45 states and the District of Columbia, 384 eating disorder treatment centers providing intensive services were found. Five states had no treatment centers. Of the treatment centers found, only about one-quarter accepted Medicaid, and >90% accepted commercial health insurance. States with a lower proportion of Medicaid-accepting treatment centers tended to have larger populations, a higher percentage of the population living in urban areas, and more eating disorder treatment centers operated by large chains. Medicaid reimbursement rates did not appear to be significantly associated with care access, but these rates were not available in many states. CONCLUSIONS: Although access varied by state, most eating disorder treatment centers did not accept Medicaid. Additional studies are needed to investigate the unmet needs of Medicaid beneficiaries and ways to ensure access to adequate care.