Medicaid’s Role in Financing Health Care for Children With Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction Act

Mandell, David S.; Machefsky, Aliza M; Rubin, David M.; Feudtner, Chris; Pita, Susmita; Rosenbaum, Sara

doi:10.1111/j.1746-1561.2008.00340.x

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…One explanation for the changes between these two particular age groups is that the responsibility for paying for some of these services shifts to the education system, resulting in lower costs to Medicaid (Mandell et al 2008a). A second, more alarming interpretation is that needed services are no longer available to children of school age through Medicaid.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Variation in Health Service Use and Associated Expenditures Among Children with Autism

Cidav

Lawer

Marcus

et al. 2012

J Autism Dev Disord

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109

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This study examined differences by age in service use and associated expenditures during 2005 for Medicaid-enrolled children with autism spectrum disorders. Aging was associated with significantly higher use and costs for restrictive, institution-based care and lower use and costs for community-based therapeutic services. Total expenditures increased by 5 % with each year of age; by 23 % between 3–5 and 6–11 year olds, 23 % between 6–11 and 12–16, and 14 % between 12–16 and 17–20 year olds. Use of and expenditures for long-term care, psychiatric medications, case management, medication management, day treatment/partial hospitalization, and respite services increased with age; use of and expenditures for occupational/physical therapy, speech therapy, mental health services, diagnostic/assessment services, and family therapy declined.

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Section: Discussionmentioning

confidence: 99%

Age-Related Variation in Health Service Use and Associated Expenditures Among Children with Autism

Cidav

Lawer

Marcus

et al. 2012

J Autism Dev Disord

Self Cite

109

View full text Add to dashboard Cite

show abstract

“…In fact, some have argued that Congress’s original intent with both Medicaid and IDEA legislation was for Medicaid to cover these medically necessary expenses (Mandell et al 2008a; Noel and Shreve 2006). States have incentive to rely on Medicaid rather than IDEA funds, because the federal match for IDEA services is 17–19%, compared with between 50 and 75% for Medicaid services.…”

Section: Introductionmentioning

confidence: 99%

County-Level Variation in the Prevalence of Medicaid-Enrolled Children with Autism Spectrum Disorders

Mandell

Morales

Xie

et al. 2010

J Autism Dev Disord

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This study examined how county-level resources are associated with the identification of children with autism spectrum disorders (ASD) in Medicaid. Medicaid claims from 2004 were combined with county-level data. There were 61,891 children diagnosed with ASD in the Medicaid system in 2004. Counties with lower per-student education expenditures, more students, a greater proportion of students in special education, higher per capita number of pediatricians and pediatric specialists, and a greater proportion of Medicaid enrollees and white residents had higher Medicaid prevalence. Within states, counties differ in how they implement Medicaid policies. The results suggest the substitution of education and Medicaid-reimbursed services. Our findings highlight the need for geographically targeted outreach to minority groups and clinicians to improve recognition of ASD.

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“…Children with ASD receive educational services through the Individuals with Disabilities Education Act (IDEA), which provides services necessary for children to receive a “free and appropriate education” (8,13). IDEA prohibits use of federal education funds to pay for medical care, even though this care may be related to academic functioning (14). IDEA also is under-funded.…”

mentioning

confidence: 99%

School-Based Behavioral Health Service Use and Expenditures for Children With Autism and Children With Other Disorders

Kang-Yi

Locke

Marcus

et al. 2016

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Objective This study compared use of and associated expenditures for Medicaid-reimbursed school-based and out-of-school services for children with autism spectrum disorder (ASD) and those with other psychiatric disorders. Methods Philadelphia County Medicaid claims were used to identify children ages five to 17 who received behavioral health services through Medicaid any time between October 2008 and September 2009 (N=24,271). Children were categorized into four diagnostic groups: autism spectrum disorder (ASD), conduct disorder or oppositional defiant disorder (conduct-ODD), attention-deficit hyperactivity disorder (ADHD), and other psychiatric disorders. Logistic regression analysis compared use of in-school and out-of-school behavioral health services between children with ASD and children with other psychiatric disorders. Generalized linear models with gamma distribution were used to estimate differences in Medicaid expenditures for in-school and out-of-school services and total Medicaid expenditures for both service types by disorder, with adjustments for age, sex, and race-ethnicity. Results The most common diagnosis was ADHD (40%); 35% had other psychiatric disorders, 21% had conduct-ODD, and 4% had ASD. A significantly greater proportion of children with ASD (52%) received in-school behavioral health services (conduct-ODD, 5%; ADHD, 8%; and other psychiatric disorders, 1.7%) Per-child expenditures for both school-based and outof-school behavioral health services were significantly higher for children with ASD than for children in the other groups. Conclusions Medicaid represents an important source of in-school and out-of-school care for children with ASD and their families. States that expand Medicaid under the Affordable Care Act should give careful consideration to covering school-based mental health services for children with ASD.

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Medicaid’s Role in Financing Health Care for Children With Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction Act

Cited by 9 publications

References 18 publications

Age-Related Variation in Health Service Use and Associated Expenditures Among Children with Autism

Age-Related Variation in Health Service Use and Associated Expenditures Among Children with Autism

County-Level Variation in the Prevalence of Medicaid-Enrolled Children with Autism Spectrum Disorders

School-Based Behavioral Health Service Use and Expenditures for Children With Autism and Children With Other Disorders

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