Adolescent Mental Health and the Role of Medicaid Managed Care

PROJECT SUMMARY The United States faces an unprecedented mental health crisis among children and adolescents. In 2021, 29% of high school students reported experiencing poor mental health. Almost 60% of female students experienced persistent feelings of sadness during the past year, and nearly 25% made a suicide plan – an increase of 60% since 2011. Emergency department (ED) visits for mental health conditions among children and adolescents have also risen sharply. Individuals aged 14-18 have rates of ED visits for suicidal ideation that are higher than any other group and more than twice the national average. In 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association jointly declared a national emergency in child and adolescent mental health. The Medicaid program can play a critical role in addressing this mental health crisis. Medicaid is the largest national payer for mental health services and, in 2022, covered 50% of all children and adolescents in the U.S. Most of these children and adolescents receive care through Medicaid managed care organizations (MCOs), making MCOs a powerful mechanism for addressing the pediatric mental health crisis. However, little is known about how MCOs and state programs influence mental health care and outcomes for children and adolescents. The proposed mixed-methods study addresses this gap using the Transformed Medicaid Statistical Information System Analytic Files (TAF), a national Medicaid claims data set that includes comprehensive enrollment and service utilization claims and detailed information on MCO and providers. These quantitative analyses will be integrated with qualitative interviews with MCOs, Medicaid administrators, and other stakeholders. Our aims to seek (1) to characterize MCO structures using latent class analysis; (2) to assess associations between MCO structures and mental health access and utilization for adolescents with anxiety, depression, and suicide- related behaviors; (3) to test the implications of MCO exit on mental health access and utilization for adolescents; and (4) to test the impacts of acute adolescent mental health events on adult caregivers. The study will also be informed by close coordination with a deployment-focused advisory committee, which will assist in identifying feasible and scalable policies and processes that can improve access and outcomes related to child and adolescent mental health. In response to PAR-23-095, our proposed study will identify policies and factors that affect access, utilization, and outcomes, using large Medicaid claims datasets and leveraging an existing data management approach to advance our research.