title: Effects on outpatient and emergency mental health care of strict Medicaid early periodic screening, diagnosis, and treatment enforcement.
abstract: We investigated enforcement of mental health benefits provided by California Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Enforcement, compelled by a consumer-driven lawsuit, resulted in an almost 4-fold funding increase over a 5-year period. We evaluated the impact of enforcement on outpatient treatment intensity (number of visits per child) and rates of emergency care treatment. Using fixed-effects regression, we examined the number of outpatient mental health visits per client and the percentage of all clients using crisis care across 53 autonomous California county mental health plans over 32 three-month periods (quarters; emergency crisis care rates) and 36 quarters (out-patient mental health visits). Enforcement of EPSDT benefits in accordance with federal law produced favorable changes in patterns of mental health service use, consistent with policy aims.
authors.affiliation: School of Social Welfare and the Center for Mental Health Services Research, Institute of Personality and Social Research, University of California, Berkeley, CA 94720-7400, USA. snowden@berkeley.edu
authors.forename: Lonnie R
authors.initials: LR
authors.lastname: Snowden
authors.forename: Mary C
authors.initials: MC
authors.lastname: Masland
authors.forename: Neal T
authors.initials: NT
authors.lastname: Wallace
authors.forename: Allison
authors.initials: A
authors.lastname: Evans-Cuellar
mesh_terms: D002140:California; D002648:Child; D002662:Child Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data / Q000600:supply & distribution; D004637:Emergency Services, Psychiatric / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000600:supply & distribution; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008484:Medicaid / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D008605:Mental Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data / Q000600:supply & distribution; D009819:Office Visits; D010045:Outpatients; D012044:Regression Analysis; D014481:United States