Medicaid managed care and the unmet need for mental health care among children with special health care needs.
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).


METHODS
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.


METHODS
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.


METHODS
The National Survey of CSHCN conducted telephone interviews with a sample representative at both the national and state levels.


RESULTS
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.
Tang
Michael H
MH
Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114, USA.
Hill
Kristen S
KS
Boudreau
Alexy A
AA
Yucel
Recai M
RM
Perrin
James M
JM
Kuhlthau
Karen A
KA
D000293:Adolescent; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D008605:Mental Health Services; D014481:United States