A multi-site study of medicaid-funded managed care versus fee-for-service plans' effects on mental health service utilization of children with severe emotional disturbance

Abstract

Although Medicaid-funded managed care arrangements are commonly used in the delivery of mental health and substance abuse services to low-income children and youth, little is known about the effectiveness of such efforts. This article examines differences in mental health services utilization between children and youth with severe emotional disturbance covered by Medicaid-funded managed care behavioral health plans and those covered by fee-for-service plans. Data are from a federally funded multi-site study. In multivariate analyses controlling for child and caregiver demographic and clinical factors, enrollment in a managed care behavioral health plan was associated with lower inpatient/residential, psychiatric medication, and nontraditional services utilization. No difference was found in outpatient services utilization. Medicaid-funded managed care behavioral health plans appear to reduce use of some types of mental health services, but it is important to address the question of whether low-income children's enrollment in such programs deprives them of needed services.

Factors Contributing to Reduced Caregiver Strain in a Publicly Funded Child Mental Health System

“…While greater caregiver strain is associated with greater initial use of child mental health services (Brannan & Heflinger, 2006; Bussing, Mason, Leon, & Sinha, 2003; Cook et al, 2004; Garland, Aarons, Hawley, & Hough, 2003; Shin & Brown, 2009), it is also associated with long gaps in treatment (Brannan et al, 2003), poor service coordination (Yatchmenoff, Koren, Friesen, Gordon, & Kinney, 1998), and premature treatment drop-out in community mental health settings (Pellerin, Costa, Weems, & Dalton, 2010). Additionally, higher levels of caregiver strain predict use of more costly services, including psychiatric hospitalization (Bickman, Foster, & Lambert, 1996), residential or inpatient care (Brannan et al, 2003; Cook et al, 2004), and medication use (Cook et al, 2004). Subjective internalized strain in particular appears to be associated with receiving a higher level of care and more inconsistent care (Brannan et al, 2003).…”

Contextual determinants associated with children’s and adolescents’ mental health care utilization: a systematic review

“…Region of residence was associated with mental health care utilization [ 35 , 41 , 47 , 52 , 54 , 64 , 99 , 105 ]. However, the direction of association is not straightforward for this determinant as this highly depends on which regions were compared with each other and which region served as the reference.…”

The Role of Quality Service Systems in Involving Families in Mental Health Treatment for Children With Severe Emotional Disturbances

“…As part of this larger multi-state study (Cook et al, 2004), in-depth standardized face-to-face interviews were conducted with caregivers of children enrolled in Medicaid who had a serious emotional disorder (SED) and the identified child (if age 12 or older) at first contact in the study (baseline) and again six-months after the initial interview (follow-up). Baseline interviews occurred as families agreed to participate in the study, which could have been up to several years after the initial Medicaid-funded mental health service that identified the sample for recruitment.…”

“…Baseline interviews occurred as families agreed to participate in the study, which could have been up to several years after the initial Medicaid-funded mental health service that identified the sample for recruitment. All of the children in this study were receiving ongoing mental health treatment paid by Medicaid at baseline, thus this study was not a program evaluation or intervention study but, rather, a longitudinal study of children with SED (see also Cooke et al, 2004). …”

“…We hypothesize that children in more rural areas will have lower levels of family involvement, based on evidence that rural families may be less likely to receive adequate mental health treatment (Hartley, 2004; Hartley, Bird, & Dempsey, 1999) and that increased distance from treatment facility is associated with a decrease in family involvement (Baker et al, 1993; Robinson et al, 2005). Finally, we predict that children residing in the state of Mississippi will have increased levels of family involvement, because the fee for service system has been linked to increased access to behavioral health services, as compared to the managed care system in Tennessee (Brannan & Heflinger, 2005; Cook et al, 2004). …”