Profile of Medicaid enrollees with sickle cell disease: A high need, high cost population

Sickle cell disease is a progressively debilitating genetic condition that affects red blood cells and can result in a variety of serious medical complications, reduced life expectancy, and diminished quality of life. Medicaid nationwide covered 66 percent of sickle cell disease hospitalizations in 2004 and 58 percent of emergency department visits for the disease between 1999 and 2007. Using Medicaid data from four states with large populations that account for more than one-third of Medicaid program enrollment, we examined the characteristics of those with sickle cell disease. We found instances of mortality rates more than nine times the age-adjusted population average (in Texas, a mortality rate for Medicaid enrollees with SCD of 1.11 percent compared to 0.12 percent overall); rates of disability-related eligibility-which is associated with long-term Medicaid enrollment-of up to 69 percent; and half or more of affected enrollees having (all-cause) hospital stays, emergency department visits, and opioid prescription fills. With gene therapies on the horizon that will spur discussions of treatment coverage, costs, and outcomes for people with sickle cell disease, it is important for relevant stakeholders to understand the affected populations.

Automated summary

Sickle cell disease is a genetic condition that can lead to serious medical complications and decreased quality of life. Medicaid covered a significant portion of hospitalizations and emergency department visits related to the disease in the early 2000s. Data from four states with large populations showed higher mortality rates, rates of disability-related eligibility, and healthcare utilization among Medicaid enrollees with sickle cell disease. With gene therapies on the horizon, it is important for stakeholders to understand the affected populations and address coverage, costs, and outcomes.