 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Ramesh Raghavan, MD, Departments of Pediatrics and Health Services, UCLA/RAND Center for Adolescent Health Promotion, University of California, Los Angeles, UCLA Box 951752, Los Angeles, CA 90095-1752, (310) 825-2178, rraghavan@mednet.ucla.edu, Arleen A. Leibowitz, PhD, Public Policy, UCLA, Public Policy Bldg, Los Angeles, CA 90095, Ronald M. Andersen, PhD, Department of Health Services, UCLA, 10833 Le Conte Avenue, Room 31-254A CHS, Los Angeles, CA 90024-1006, Mark A. Schuster, MD, PhD, RAND, P.O. Box 2138, 1700 Main Street, Santa Monica, CA 90407-2138, and John A. Landsverk, PhD, Child & Adolescent Services Research Center, 3020 Children's Way MC5033, San Diego, CA 92123.
Introduction: Children in the child welfare system have high mental health needs, and depend upon Medicaid to finance access to mental health care. The effects of Medicaid managed behavioral care on this population are unknown. This study examines how variations in Medicaid managed care policies affect access to ambulatory mental health services for children in child welfare.
Methods: The National Survey of Child and Adolescent Well-Being (NSCAW) is a panel study that provides individual-level data for 6,231 children in child welfare. The Caring for Children in Child Welfare study uses key informant interviews to obtain county-level Medicaid policy information. We merged these datafiles, and analyzed relationships between county-level policies and children’s mental health utilization.
Results: A quarter of all children saw a specialist mental health provider. On logistic regression, older age, out-of-home placement, higher physical and emotional morbidity, and having a college-educated caregiver were associated with higher odds of receiving mental health care. Medicaid policy variables were only significant for children placed out-of-home. Children resident in counties with behavioral carve-outs had higher odds of access to mental health services. Fee-for-service provider reimbursement was associated with higher odds of specialist care.
Discussion: Medicaid managed care policies may have little effect on child welfare children placed in-home. Behavioral carve-outs with fee-for-service provider reimbursement may best promote access to mental health care for children placed out-of-home.
Learning Objectives:
Awards: The Kenneth Lutterman Award for Exemplary Student Papers in Mental Health - Honorable Mention
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.