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Medicaid Managed Care and the Unmet Need for Mental Health Care among Children with Special Health Care Needs
Author(s) -
Tang Michael H.,
Hill Kristen S.,
Boudreau Alexy A.,
Yucel Recai M.,
Perrin James M.,
Kuhlthau Karen A.
Publication year - 2008
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2007.00811.x
Subject(s) - medicaid , medicine , mental health , managed care , family medicine , medicaid managed care , health care , odds ratio , medline , gerontology , psychiatry , political science , law , pathology , economics , economic growth
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.