Medicaid Expenditures on Psychotropic Medications for Maltreated Children: A Study of 36 States

Abstract

Objective Children with histories of abuse or neglect are the most expensive child population to insure for their mental health needs. This paper quantifies the magnitude of Medicaid expenditures incurred on the purchase of psychotropic drugs for these children. Methods Child participants (N=4445) in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – were linked to their Medicaid claims from 36 states. Expenditures on psychotropic mediations between the NSCAW sample and a propensity score-matched comparison sample were compared using a two-part regression of logistic and generalized linear models. Results Children surveyed in NSCAW had twice the odds of psychotropic drug use, and $190 higher mean annual expenditures on psychotropic drugs than those in the comparison sample. Increased expenditures on antidepressants and antimanic drugs were the primary drivers of these increased expenditures. Male gender and white race/ethnicity were associated with significantly increased expenditures. Children in primary care case management had $325 lower expenditures than those in fee-for-service Medicaid. Among NSCAW children alone, male gender, older age, being in poorer health, and scoring in the clinical range of the Child Behavior Checklist all increased expenditures on psychotropic drugs. Conclusions Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.

Children Exposed to Maltreatment: Assessment and the Role of Psychotropic Medication

“…6,7 Children and adolescents involved with the child welfare system are 2 to 3 times more likely to be treated with psychotropic medication compared with those without such involvement. 8,9 In addition, 33% of all foster children are prescribed a psychotropic medication. Among Medicaid-eligible children, foster children are approximately 4 times more likely to be prescribed a second-generation antipsychotic than children not in foster care, 10 with 10% of foster children receiving 3 or more psychotropic medications at any given time.…”

Comparative spending of medicaid dollars on child participants of Kentucky’s sobriety treatment and recovery teams program versus a matched comparison group.

“…This study is unique from much of the past work done in this area for two related reasons: (1) It makes comparisons between two groups where one received an experimental intervention, and as such, (2) It makes comparisons between groups of children in which both groups have been exposed to maltreatment. Many past studies have been designed to investigate the effects of victimization vs. non-victimization (e.g., Raghavan et al, 2014;Florence et al, 2013). For this reason, comparisons between the results of this study and past work that did not involve study groups where the entire sample was exposed to maltreatment are limited in their ability to draw broader conclusions.…”

“…These findings may also be placed in context alongside the work described in Raghavan, Brown, Allaire, Garfield, & Ross (2014), which examined Medicaid expenditures on psychotropic medications for children who had been the victim of maltreatment. They found that children who had been the identified victim on a CPS case had twice the odds of receiving any psychotropic drug prescription, and $190 higher mean annual expenditures on psychotropic drugs than PSM-matched children who were never victims.…”

“…These included the restriction of eligibility for inclusion in the comparison group to certain case characteristics (e.g., substance use was a risk factor), individual child characteristics (e.g., child was under the age of 6, the youngest in their family), and geographic characteristics (e.g., only children from the same region of Kentucky were matched) before the data was submitted to PSM. Notably, this study included known risk factors such as domestic violence, poverty, and parental mental illness in the PSM modela notable improvement on similar investigations of treatment effects in child welfare settings (see Florence et al, 2013;Raghavan, Brown, Allaire, Garfield, & Ross, 2014;Johnson-Motoyama et al, 2013). These decisions for this study were informed and supported by the methodological insights found in Barth, Guo, & McCrae (2008) and Rubin (1997).…”

“…Although this study included data from a longer period of time than others who used a similar method with similar samples (e.g., Raghavan et al, 2014 -1 year follow up), it is still possible that the window was too short to detect meaningful differences between the START and comparison groups. In the Weisner and colleagues (2010) study mentioned above, significant reductions in healthcare spending on family members of successfully treated addiction treatment clients were not detected until five years after their entry into treatment.…”