Funder: The Annie E. Casey Foundation, the Substance Abuse and Mental Health Services Administration, and The Commonwealth Fund

Author: Sheila Pires, Katherine Grimes, Todd Gilmer, Kamala Allen, Roopa Mahadevan, and Taylor Hendricks

December 2013 | Brief, Report


children-behavioral-medicaid-utilization

Less than 10 percent of children in Medicaid use behavioral health care, but this care accounts for roughly 38 percent of Medicaid expenditures for children.”

Most children enrolled in Medicaid are from low-income households and many are served by multiple public programs, putting them at risk for receiving fragmented or inappropriate care. This risk is even higher for children in Medicaid with behavioral health needs, who often experience poor health outcomes at high costs.

To help states uncover opportunities to improve care for these children, the Center for Health Care Strategies analyzed behavioral health care use and expense for children in Medicaid in all 50 states. The study reveals that:

  • Less than 10 percent of children in Medicaid use behavioral health care, but this care accounts for roughly 38 percent of Medicaid expenditures for children;
  • Children in foster care and those on SSI/disability represent one-third of the Medicaid child population using behavioral health care, but 56 percent of total behavioral health expenses; and
  • Almost 50 percent of children in Medicaid prescribed psychotropic medications received no accompanying identifiable behavioral health services, like medication management.

Key findings from the analysis are highlighted in an issue brief, which suggests opportunities for state policymakers and other key stakeholders to improve the quality and cost-effectiveness of health care for children in Medicaid with serious behavioral health needs. For the complete study methodology and findings, download the full report. CHCS is currently pursuing a second phase of this study using 2008 claims data.

Access the chartbook for data graphs from the study to use in presentations or other resources.

View Q&A results from CHCS’ November 20, 2013 webinar, Faces of Medicaid Data Analysis: Identifying Opportunities to Improve Children’s Behavioral Health.