Medicaid Managed Care and the Unmet Need for Mental Health Care among Children with Special Health Care Needs

Authors

  • Michael H. Tang,

    1. Harvard Medical School, Boston, MA
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  • Kristen S. Hill,

    1. Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Alexy A. Boudreau,

    1. Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Recai M. Yucel,

    1. Division of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, NY.
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  • James M. Perrin,

    1. Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Karen A. Kuhlthau

    1. Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114
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    • Address correspondence to Karen A. Kuhlthau, Ph.D., Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114. Michael H. Tang, M.D., is with Harvard Medical School, Boston, MA. Kristen S. Hill, M.P.H., Alexy Arauz Boudreau, M.D., M.P.H., and James M. Perrin, M.D., are with the Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Recai M. Yucel, Ph.D., is with the Division of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, NY.


Abstract

Objective. To determine the association between Medicaid managed care pediatric behavioral health programs and unmet need for mental health care among children with special health care needs (CSHCN).

Data Source. The National Survey of CSHCN (2000–2002), using subsets of 4,400 CSHCN with Medicaid and 1,856 CSHCN with Medicaid and emotional problems. Additional state-level sources were used.

Study Design. Multilevel models investigated the association between managed care program type (carve-out, integrated) or fee-for-service (FFS) and reported unmet mental health care need.

Data Collection/Extraction Methods. The National Survey of CSHCN conducted telephone interviews with a sample representative at both the national and state levels.

Principal Findings. In multivariable models, among CSHCN with only Medicaid, living in states with Medicaid managed care (odds ratio [OR]=1.81; 95 percent confidence interval: 1.04–3.15) or carve-out programs (OR=1.93; 1.01–3.69) were associated with greater reported unmet mental health care need compared with FFS programs. Among CSHCN on Medicaid with emotional problems, the association between managed care and unmet need was stronger (OR=2.48; 1.38–4.45).

Conclusions. State Medicaid pediatric behavioral health managed care programs were associated with greater reported unmet mental health care need than FFS programs among CSHCN insured by Medicaid, particularly for those with emotional problems.

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