Medicaid Waivers for Youth with Severe Emotional Disturbance: Associations with Public Health Coverage, Unmet Mental Health Needs & Adequacy of Health Coverage

Lagging coverage for mental health services among children and adolescents through home and community‐based Medicaid waivers

“…Children and adolescents with SED are at increased risk for school drop-out, increased risk of substance use, criminal justice involvement, and the potential to harm themselves or others (Graaf & Snowden, 2018;Graaf et al, 2021). Further, families and caregivers are also significantly impacted by children and adolescents with SED with reports of significant strain in the family, particularly in anxiety, depression, and distress (Corliss et al, 2008).…”

“…Children and adolescents with a diagnosis representing those with a “serious emotional disturbance” (SED) have both a diagnostic and statistical manual of mental disorders‐based psychiatric or mental health condition and concurrent symptoms that impair functioning in school, home, or the community, and represent 8%–12% of all youth in the United States (Costello et al, 2005 ; Williams et al, 2018 ). Children and adolescents with SED are at increased risk for school drop‐out, increased risk of substance use, criminal justice involvement, and the potential to harm themselves or others (Graaf & Snowden, 2018 ; Graaf et al, 2021 ). Further, families and caregivers are also significantly impacted by children and adolescents with SED with reports of significant strain in the family, particularly in anxiety, depression, and distress (Corliss et al, 2008 ).…”

“…Among children and youth with co‐existing medical complexity or multimorbidity, the prevalence of children and adolescents with concurrent SED is estimated to be between 30% and 50% (Einfeld et al, 2011 ). Children and adolescents with severe impairments either from SED alone or SED along with medical complexity need access to intensive services to be able to remain in home and community‐based settings (Graaf & Snowden, 2019 ; Graaf et al, 2021 ). Care delivered in the home and community‐based setting is a critical place of treatment for many SED, children with medical complexity (CMC), and other developmental disabilities (Barnert et al, 2018 ).…”

“…With general historical movements away from institutional settings and toward engagement with home‐and community‐based services, Medicaid waivers are an important piece of this model of care coverage. Specifically, among youth with SED, Graaf et al ( 2021 ) found that youth that lived in a state with Medicaid waiver coverage had reduced odds of unmet mental health needs. There is very limited data on the scope of services offered for 1915(c) waivers targeted toward children, generally, and particularly children and adolescents with SED.…”