Children in Medicaid with behavioral health needs are one of the program’s most vulnerable populations — representing a small percentage of the overall Medicaid child population, but accounting for disproportionate costs. These children are often served by multiple public programs, putting them at risk for fragmented or uncoordinated care, and they often experience poor health outcomes at high costs.

In March, a preview of CHCS upcoming national analysis of 2011 Medicaid claims data was shared at the 30th Annual Research and Policy Conference for Child, Adolescent, and Young Adult Behavioral Health. Highlights of the upcoming full report, made possible through support from the Annie E. Casey Foundation, reveal:

  • Roughly 11 percent of children in Medicaid use behavioral health services, accounting for an estimated 36 percent of program expenditures for children.
  • Mean expenses for children in Medicaid using behavioral health services are 4x higher than for the general Medicaid child population.
  • Children in foster care and those on SSI/disability represent less than eight percent of the overall Medicaid child population, but 28 percent of children using behavioral health services and 49 percent of total behavioral health service expenses.
  • Almost 50 percent of children in Medicaid who are prescribed psychotropic medications receive no accompanying identifiable behavioral health services, like medication management or counseling.

Targeting Opportunities to Improve Behavioral Health Services for Children

The full analysis, targeted for release in 2018, is part of CHCS’ ongoing Faces of Medicaid data analysis series designed to uncover patterns of behavioral health service usage for children in Medicaid and to inform state Medicaid efforts to improve services for this population. Over the last five years, in partnership with Sheila A. Pires, MPA, Human Service Collaborative, and Todd Gilmer, PhD, University of California, San Diego, CHCS has undertaken these analyses to identify: (1) behavioral and physical health service use and expense; (2) psychotropic medication use; and (3) patterns of use among children in foster care and those with developmental disabilities. The first analysis, which looked at 2005 claims data, revealed key opportunities for states and other stakeholders to improve outcomes for children in Medicaid with behavioral health needs, including:

  • Expanding access to appropriate and effective behavioral health care, particularly therapeutic interventions with an existing or emerging evidence base, and home- and community-based services;
  • Investing in care coordination models that use a wraparound approach to facilitate delivery of needed supports and services for vulnerable populations; and
  • Ensuring collaboration across child-serving systems to increase care coordination and improve oversight and monitoring of psychotropic medication use.

For more information, including the original analysis of 2005 claims data, see: Resource Compendium: Children’s Faces of Medicaid Resources.

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Frank A. Fecser
6 years ago

In Cleveland, Ohio Positive Education Program , a mental health agency, operates PEP Connections. PEP Connections was developed in 1989 through a Robert Wood Johnson Foundation grant to support wrap around and service integration for children who are involved in multiple public systems and are at risk for removal from home. A Medicaid 1915(a) option has been a key part of funding for PEP Connections. The program has been successful in preserving families and preventing placement for some of the County’s most at risk children and young people. The State has decided to retire the 1915(a) option in January 2018… Read more »