Exploding asthma and ADHD caseloads: The role of medicaid managed care

Abstract

In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This increase has been concentrated in the Medicaid caseload nationwide. One of the most striking changes in Medicaid has been the transition from fee-for-service (FFS) reimbursement to Medicaid managed care (MMC), which had taken place in 80% of states by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads. Empirically, we rely on variation in MMC enrollment due to a change in the “default” Medicaid plan from FFS to MMC, and on rich panel data that allow us to follow the same children before and after they were required to switch. We find that the transition from FFS to MMC explains about a third of the rise in the number of Medicaid children being treated for ADHD and asthma, along with increases in treatment for many other conditions. These are likely to be due to the incentives created by the risk adjustment and quality control systems in MMC.

Child health as human capital

“…Event studies with county fixed effects. This figure reproduces parts of Figure 6 in Chorniy et al (), who include children from the 2 years before to the 2 years after the change to managed care in a South Carolina county. © Elsevier 2018…”

“…Chorniy, Currie, and Sonchak () examine the impact of maternal participation during pregnancy in the Supplemental Feeding Program for Women, Infants, and Children (WIC) program. As its name suggests, WIC is primarily thought of as a nutrition program, but it is often administered through maternal and child health clinics, and WIC centers are charged with facilitating access to medical care.…”

“…Percent increase in diagnoses in 12 months after switch to managed care. This figure illustrates estimates that are taken from Chorniy et al (), who follow the same child over time and ask what happens to the probability of being diagnosed or treated with a condition following the child's enrollment in Medicaid managed care…”

“…We saw above, for example, that Miller and Wherry found evidence that children whose mothers were eligible for Medicaid coverage of their pregnancies (most of whom would have received such coverage if they were otherwise uninsured) had lower mental distress scores in young adulthood. Chorniy, Currie, and Sonchak (2018) examine the impact of maternal participation during pregnancy in the Supplemental Feeding Program for Women, Infants, and Children (WIC) program. As its name suggests, WIC is primarily thought of as a nutrition program, but it is often administered through maternal and child health clinics, and WIC centers are charged with facilitating access to medical care.…”

The Roots of Health Inequality and The Value of Intra-Family Expertise

“…23 To calculate parental household income rank at birth, we average two years of annual earnings of the child's mother and father, measured one and two years before the child's birth, respectively; sum them into household income; and rank households within each child's birth cohort. 24 Asthma is affecting nearly ten percent of all children in the United States (Chorniy et al 2018); and in Sweden, already at age five roughly 11 percent are affected by asthma.…”