title: Racial/ethnic differences in Medicaid expenditures on psychotropic medications among maltreated children.
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.
authors.affiliation: Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, USA.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Raghavan
authors.affiliation: Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, USA.
authors.forename: Derek S
authors.initials: DS
authors.lastname: Brown
authors.affiliation: RTI International, PO Box 12194, Research Triangle Park, NC 27709, USA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Allaire
authors.affiliation: Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, USA.
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Garfield
authors.affiliation: Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, USA.
authors.forename: Raven E
authors.initials: RE
authors.lastname: Ross
authors.affiliation: University of California, Berkeley, School of Public Health, 50 University Hall, #7360, University of California, Berkeley, Berkeley, CA 94720-7360, USA.
authors.forename: Lonnie R
authors.initials: LR
authors.lastname: Snowden
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000191:economics; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000188:drug therapy / Q000191:economics*; D011619:Psychotropic Drugs / Q000191:economics* / Q000627:therapeutic use; D014481:United States / Q000208:ethnology
chemical_list: D011619:Psychotropic Drugs
keywords: Disparities; Ethnicity; Expenditures; Medicaid; Psychotropic drugs; Race