Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care

Breslau, Joshua; Stein, Bradley D.; Yu, Hao; Han, Bing

doi:10.1007/s10488-018-0895-5

Cited by 3 publications

(7 citation statements)

References 29 publications

(36 reference statements)

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“…Though public and not-for-profit agencies have historically operated most community mental health facilities, insurance expansions-through Medicaid expansion, dependent coverage expansion under the Affordable Care Act (ACA), and increased generosity of coverage due to the Mental Health Parity and Addiction Equity Act (MHPAEA)-could lead to an increase in for-profit ownership and changes in the types of services offered. [29][30][31] For example, private equity firms have invested in behavioral health treatment facilities and cited insurance expansions as their motivation. [32][33][34] Per the annual National Mental Health Services Survey (N-MHSS), the share of facilities operated by for-profit organizations doubled between 2010 and 2020 from 10% to 21%.…”

Section: S Erious Mental Illness (Smi) Can Cause Sig-mentioning

confidence: 99%

“…Facility ownership could also influence the availability of specialty mental health services. Though public and not‐for‐profit agencies have historically operated most community mental health facilities, insurance expansions—through Medicaid expansion, dependent coverage expansion under the Affordable Care Act (ACA), and increased generosity of coverage due to the Mental Health Parity and Addiction Equity Act (MHPAEA)—could lead to an increase in for‐profit ownership and changes in the types of services offered 29‐31 . For example, private equity firms have invested in behavioral health treatment facilities and cited insurance expansions as their motivation 32‐34 .…”

Section: Target Patient Population Patients With Serious Mental Illn...mentioning

confidence: 99%

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What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

et al. 2022

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Community mental health facilities often do not offer the full range of evidence‐based clinical and support services for individuals with serious mental illness. Facilities were no more likely to offer six of seven services studied in 2019 compared with 2010 in both Medicaid expansion and nonexpansion states. For‐profit facilities generally experienced the largest declines in service availability, while public facilities experienced the smallest declines with small increases in availability of select services. New payment models that incentivize the offer of specialty support services may be needed to encourage adoption of clinical and support services by specialty mental health organizations. Context Community mental health facilities often do not offer the full range of evidence‐based clinical and support services for individuals with serious mental illness. This creates equity issues, particularly when low‐income and minority communities have access to fewer facilities. Medicaid expansion might encourage facilities to offer these services. However, this decision may also be affected by facility ownership type or mediated by service cost structure, particularly in the absence of innovative payment mechanisms. In this study, we determine whether and how Medicaid expansion and facility ownership are associated with changes in specialty mental health service availability in organized settings over time. Methods We estimated two‐way fixed effects models using six cross‐sections of the National Mental Health Services Survey and compared changes in facility‐reported offering of seven services from 2010 to 2019 (54,885 facility years): psychotropic medication, case management, family psychoeducation, psychiatric emergency walk‐in services, supported employment, assertive community treatment, illness management, and recovery services. We tested whether Medicaid expansion and facility ownership (private for‐profit, private not‐for‐profit, public) were associated with differential changes in service availability from 2010 to 2019. Findings Overall, facilities were no more likely to offer nearly all services in 2019 than 2010. We found smaller declines for psychotropic medication and psychiatric emergency walk‐in services among facilities in Medicaid expansion states compared to declines in non‐Medicaid expansion states (6.3 (95% CI 95% CI = 1.8‐10.7) and 5.5 (95% CI = 0.2‐10.8) percentage points respectively). For‐profit facilities experienced the largest declines in availability from 2010 to 2019, while public facilities experienced the smallest declines and some increases in availability of select services. Conclusions Specialty mental health services are still not widely offered in community outpatient settings despite significant investments in Medicaid, although Medicaid expansion was associated with slower declines in availability. New payment models that incentivize outpatient facilities to offer clinical and support services may be needed.

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Section: S Erious Mental Illness (Smi) Can Cause Sig-mentioning

confidence: 99%

Section: Target Patient Population Patients With Serious Mental Illn...mentioning

confidence: 99%

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

et al. 2022

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“…For example, many of the services for secondary, tertiary, and quaternary prevention (e.g., child therapy, substance abuse and psychiatric treatment for parents) could be funded by traditional Medicaid, Medicare, Affordable Care Act products, or private insurance. In fact, research suggests that the Affordable Care Act's Dependent Care Expansion (DCE) increased utilization of mental health treatment by those with high needs (Breslau et al 2018). The CDC's technical package for preventing CAN suggests a variety of financing options at various levels of the prevention continuum (e.g., tax credits, child support payments, subsidized child care; Forston et al 2016).…”

Section: Multi-sourced Fundingmentioning

confidence: 99%

Achieving Comprehensive Prevention of Child Abuse and Neglect

Risser

Svevo-Cianci²,

Karim³

et al. 2019

Int. Journal on Child Malt.

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The United States has developed a comprehensive array of child abuse and neglect (CAN) prevention resources and has allocated funding to provide these resources. Policy makers, practitioners, and advocates are committed to CAN prevention. However, the current paradigm used to prevent CAN is inadequate for four reasons. First, system-level policies and infrastructure are not fully aligned with children's needs for a safe and stable upbringing. Second, access to effective CAN prevention resources is not ubiquitous. Third, most people do not have clear roles in preventing CAN in their everyday lives. Fourth, fear of stigma prevents caregivers from seeking support and accessing services. We must shift the paradigm so that all policies promote child well-being, every family has equitable access to all opportunities, and every individual feels entitled to advocate for and engage in CAN prevention. By embedding an adapted Health Belief Model (aHBM) into an ecological model, we can improve policies, behaviors, and beliefs at all levels of the social ecology in order to shift the paradigm. In order to scale knowledge and advocacy for preventing CAN to the population, we propose a strategy that increases system collaboration, leverages existing infrastructure, and adopts multi-source funding models that invest in prevention services to inoculate society against CAN.

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“…Three studies used difference-in-differences designs based on the ACA’s dependent coverage provision, which increased the age that children of policyholders were eligible for dependent insurance coverage to 26 in September 2010. Two studies found no evidence of effects on access and utilization of prescriptions (Kotagal et al, 2014; Shane et al, 2016), while one found that insurance coverage increased prescription drug utilization among young adults with mental health conditions (Breslau et al, 2019). In the most similar study to this one, DiNardi (2021) used a regression discontinuity design (RDD) to examine changes in prescription drug utilization at age 26, the cutoff for dependent insurance coverage eligibility.…”

Section: Introductionmentioning

confidence: 99%

“…The four most closely related studies of insurance coverage and prescription drug utilization for young adults found mixed results and were limited by their reliance on survey data that had few observations for people close to age 26 (Breslau et al, 2019; DiNardi, 2021; Kotagal et al, 2014; Shane et al, 2016). This study contributes to the literature by assessing the relationship using detailed, comprehensive data with millions of prescription records for people close to age 26.…”

Section: Introductionmentioning

confidence: 99%

Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky

Meille

2023

Med Care Res Rev

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This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky’s prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II–V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.

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Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care

Cited by 3 publications

References 29 publications

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

Achieving Comprehensive Prevention of Child Abuse and Neglect

Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky

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