I have not read the study but there are disparities in Medicaid cost reimbursements for heavily populated urban centers with high rates of poverty. The same holds true for some rural areas. This is why few doctors, including dentist, will practice: they cannot afford it. Medicaid for child welfare services pays much more in the suburbs.
Child welfare is, typically, the only means to access mental health treatment. It is termed "voluntary placement" in order for the court to approve Medicaid payments. These volunteer placements are then lumped into the "abuse and neglect" reporting of SACWIS.
Psychotropic medication is used in child welfare as chemical constraints due to a severe lack of funding for direct services. It is easier to dope the kids.
Only for brevity do I cite my last reason to take heed to the onerous foreshadowing of this study; there is no oversight to Medicaid in child welfare because it is a secret.
Abstract
This study quantifies racial/ethnic differences in Medicaid expenditures on psychotropic drugs among a national sample of children with suspected maltreatment. We linked 4,445 child participants in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – to their Medicaid claims obtained from 36 states. We used propensity score matching to construct a comparison group of children without known child welfare involvement, and estimated two-part generalized linear models to examine differences in annual psychotropic drug expenditures per child between children of different races/ethnicities. When compared to a matched sample of children, African American and Latino children incur $292 and $144 less expenditures on psychotropic drugs, respectively, than white children. Among NSCAW children alone, African American children display $614 less spending on psychotropic drugs when compared to white children. Racial/ethnic differences in expenditures on psychotropic drugs occur among all children on Medicaid, but the differences are especially pronounced among African American children in contact with the child welfare system. These findings demonstrate that policymakers will need to pay special attention to the needs of children of color as Medicaid expansions proceed nationwide.
New study examines disparities in Medicaid spending on children in the welfare system
In the new health-care climate of the federal Affordable Care Act and efforts to expand Medicaid to accommodate more individuals and children, the need to closely examine ways to best use government funding is becoming increasingly evident.
A new study from the Brown School at Washington University in St. Louis examines racial and ethnic differences in Medicaid expenditures for children in the welfare system who use psychotropic drugs – medication for conditions such as attention deficit hyperactivity disorder, or ADHD, that affect a child’s mental state.
Raghavan
“Children in the child welfare system are the largest nondisabled users of child mental health services — and the most expensive of kids to insure for mental health needs,” said Ramesh Raghavan, MD, PhD, associate professor at the Brown School and lead author of the study.
“Most of the costs affiliated with mental health coverage are due to pharmaceuticals, and the costs of drugs is very high,” he said. “So when you think about the fact that we have around 6 million kids in contact with child-welfare systems nationally – and about half of them have some sort of behavioral or emotional condition that may require drugs for treatment — we really are looking at a huge number of kids who need mental health services.”
The study, “Racial/Ethnic Differences in Medicaid Expenditures on Psychotropic Medications Among Maltreated Children,” was published online in March in the journal Child Abuse & Neglect. The study examined 4,445 child participants in the National Survey of Child & Adolescent Well-Being linked to their Medicaid records in 36 states. It found expenditure differences were especially pronounced among African-American children. Spending on African-American children was between $300 and $600 lower than spending on white children.
The study can be read online here. But the takeaway, Raghavan said, is that expanding coverage through Medicaid alone may be insufficient to assure high-quality mental health care for children, especially children of color.
“We should be focusing on why these expenditure disparities exist, and how we can eliminate them,” he said. “We know this is not because African-American children are less sick than their white counterparts, and we know this is not entirely because of where they live. So we need to figure out why we’re spending less money on these kids of color, and whether that is appropriate or not.
“Focusing on getting more children into Medicaid without trying to understand the kinds of services these kids receive once they are in the program is not going to improve the quality of care for these kids,” he said.
Raghavan will present some findings from the study at the upcoming National Conference on Child Abuse and Neglect April 30-May 2 in New Orleans, sponsored by the Children’s Bureau, Administration for Children and Families.
Co-authors of the study are Derek S. Brown, PhD, assistant professor at the Brown School; Benjamin T. Allaire of Research Triangle Institute, North Carolina; Lauren D. Garfield, PhD, postdoctoral research scholar in the Department of Psychiatry at Washington University School of Medicine in St. Louis; Raven E. Ross, a doctoral candidate at the Brown School, and Lonnie R. Snowden, PhD, of the Unversity of California, Berkeley School of Public Health.
The study was funded by the National Institute of Mental Health and the Agency for Healthcare Research and Quality.
To read more about Raghavan and his work at the Brown School, visit here.
Voting is beautiful, be beautiful ~ vote.©
No comments:
Post a Comment