Effectiveness of a children’s home and community-based services waiver program

Solhkhah, Ramon; Passman, Cathryn L.; Lavezzi, Glenn; Zoffness, Rachel; Silva, Raul R.

doi:10.1007/s11126-007-9042-2

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Studies examining these policies in relation to mental health care for children are limited. Functional, clinical, and access-related outcomes in existing reports appear to be positive (Friesen et al, 2003; Graaf & Snowden, 2018; Ireys et al, 2006; Solhkhah et al, 2007), and a 2013 report from a federal Medicaid Waiver Demonstration project highlighted promising outcomes for these programs:Using a “systems of care” approach, the Demonstration successfully enabled participants to either improve or maintain their functioning status at less than a third of the cost of serving them in an institution . .…”

Section: Introductionmentioning

confidence: 99%

Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making

Graaf

Snowden

2020

Journal of Disability Policy Studies

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Many states have enacted Home- and Community-Based Services (HCBS) Medicaid waivers, which waive or expand Medicaid means tests to increase access to community-based public mental health services for youth with Serious Emotional Disturbance (SED). This study sought to understand key factors in State Mental Health Authorities and Medicaid Agency decision-making in adopting Medicaid waivers for youth with SED. Using purposive sampling to collect data through semi-structured interviews with officials from 37 state mental health systems, interviews focused on fiscal, historical, and political reasons for states’ adoption or rejection of Medicaid waivers to serve youth with SED. Results suggest that decisions around waiver adoption relate to the size and flexibility of state budgets, the sufficiency of existing public HCBS funding and services, political prioritization of children and families, states’ desire to move away from a reliance on residential care, and ideology related to the role of the state in providing for the welfare of children and families. Advocacy efforts promoting state waiver adoption can address apprehensions about budget constraints and providing financial assistance to non-poor families by emphasizing potential cost savings from residential diversion and ethical imperatives to keep children in their homes and communities.

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Section: Introductionmentioning

confidence: 99%

Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making

Graaf

Snowden

2020

Journal of Disability Policy Studies

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“…In both studies, it was suggested that IHT may be the preferred approach. However, IHT requires a viable living environment with parents or guardians who are willing to engage in therapy (Solhkhah et al 2007), and this home environment may not be available in some cases. It is uncertain if these fundamental differences in living environments can be controlled statistically.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes of Children and Youth accessing Residential or Intensive Home-based Treatment: Three year follow up

et al. 2010

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In this study the long-terms outcomes of children and youth with severe mental health problems receiving residential treatment (RT) or an intensive homebased treatment (IHT) were reported. RT is 24-hour mental health intervention in a highly supervised and structured group living setting where individualized and related therapies are provided. Youths attend a day school within the residential environment. IHT developed as an alternative to residential treatment for youth and comprises the same therapeutic interventions provided in the home as opposed to the residential setting. Youths attend their regular school which could be within a specialized setting, such as a day school. At discharge, there were statistically and clinically significant improvements in psychosocial functioning for children and youth in RT and IHT. There were also statistically significant improvements in scores on symptom severity from admission to 12 to 18 months post-discharge, and these improvements were maintained at 36 to 40 months post-discharge. Differences in demographic data between the two groups suggest that the programs may serve two different populations, and that both programs are important components of a comprehensive mental health plan for children and youth.

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“…Limited evaluation exists, however, regarding Medicaid waivers specifically for this population. Findings in a handful of preliminary studies of such HCBS 1915(c) waivers suggest that state adoption expands the array of community-based services available to these youth and their families, allows more families to access intensive mental health care in the community, and has helped keep more youth in their homes (Friesen et al, 2003;Ireys, Pires, & Lee, 2006;Solhkhah, Passman, Lavezzi, Zoffness, & Silva, 2007). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

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confidence: 99%

Medicaid waivers and public sector mental health service penetration rates for youth.

Graaf

Snowden

2018

American Journal of Orthopsychiatry

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To assist families of youth with serious emotional disturbance in financing youth's comprehensive care, some states have sought and received Medicaid waivers. Medicaid waivers waive or relax the Medicaid means test for eligibility to provide insurance coverage to nonpoor families for expensive, otherwise out-of-reach treatment for youth with Serious Emotional Disturbance (SED). Waivers promote treatment access for the most troubled youth, and the present study investigated whether any of several Medicaid waiver options-and those that completely omit the means test in particular-are associated with higher state-wide public sector treatment penetration rates. The investigators obtained data from the U.S. Census, SAMHSA's Uniform Reporting System, and the Centers for Medicare and Medicaid Services. Analysis employed random intercept and random slope linear regression models, controlling for a variety of state demographic and fiscal variables, to determine whether a relationship between Medicaid waiver policies and state-level public sector penetration rates could be observed. Findings indicate that, whether relaxing or completely waiving Medicaid's qualifying income limits, waivers increase public sector penetration rates, particularly for youth under age 17. However, completely waiving Medicaid income limits did not uniquely contribute to penetration rate increases. States offering Medicaid waivers that either relax or completely waive Medicaid's means test to qualify for health coverage present higher public sector treatment rates for youth with behavioral health care needs. There is no evidence that restricting the program to waiving the means test for accessing Medicaid would increase treatment access. (PsycINFO Database Record

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Effectiveness of a children’s home and community-based services waiver program

Abstract: It would seem that the HCBS program appears to be a clinically and cost-effective method of maintaining children in their community.

Cited by 12 publications

References 21 publications

Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making

Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making

Long-term Outcomes of Children and Youth accessing Residential or Intensive Home-based Treatment: Three year follow up

Medicaid waivers and public sector mental health service penetration rates for youth.

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