Screening for Behavioral Health Issues in Children Enrolled in Massachusetts Medicaid

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Use of behavioral health (BH) screens in pediatrics have increased identification of children with BH issues. Screening rates increased in Massachusetts after it was mandated, as did the volume of some mental health services. WHAT THIS STUDY ADDS:This is the first study of children after Massachusetts mandated behavioral screening began. Almost 40% of children who screened positive were newly identified. Being male, having a BH history, and being in foster care predicted a positive screen. abstract OBJECTIVES: To understand mandated behavioral health (BH) screening in Massachusetts Medicaid including characteristics of screened children, predictors of positive screens, and whether screening identifies children without a previous BH history. METHODS:Massachusetts mandated BH screening in particularly among underidentified groups. 2008. Providers used a billing code and modifier to indicate a completed screen and whether a BH need was identified. Using MassHealth claims data, children with $300 days of eligibility in fiscal year (FY) 2009 were identified and categorized into groups based on first use of the modifier, screening code, or claim. Bivariate analyses were conducted to determine differences among groups. BH history was examined by limiting the sample to those continuously enrolled in FY 2008 and 2009. Multivariate logistic regression was used to determine predictors of positive screens. RESULTS:Of 355 490 eligible children, 46% had evidence of screening. Of those with modifiers, 12% were positive. Among continuously enrolled children (FY 2008 and FY 2009) with evidence of screening, 43% with positive modifiers had no BH history. This "newly identified" group were more likely to be female, younger, minority, and from rural residences (P , .0001). Among children with modifiers; gender (male), age (5-7), being in foster care, recent BH history, and Hispanic ethnicity predicted having a positive modifier. CONCLUSIONS:The high rate of newly identified Medicaid children with a BH need suggests that screening is performing well, particularly among underidentified groups. To better assess screening value, future work on cost-effectiveness and the impact on subsequent mental health treatment is needed. Pediatrics 2014;133:46-54

Common and Costly Hospitalizations for Pediatric Mental Health Disorders

“…Previous studies of outpatient mental health care have shown that minority children are more likely to be undiagnosed 33,34 and that, among children with mental health diagnoses, black and/or Hispanic children are less likely to receive outpatient mental health services. [35][36][37][38][39] The increased adjusted likelihood of mental health hospitalization associated with race in the model that includes insurance type (Table 2) indicates that lack of insurance would not completely explain the relationship between race/ ethnicity and mental health hospitalizations.…”

Common and Costly Hospitalizations for Pediatric Mental Health Disorders

“…Previous studies of outpatient mental health care have shown that minority children are more likely to be undiagnosed 33,34 and that, among children with mental health diagnoses, black and/or Hispanic children are less likely to receive outpatient mental health services. [35][36][37][38][39] The increased adjusted likelihood of mental health hospitalization associated with…”

Behavioral Health Services Following Implementation of Screening in Massachusetts Medicaid Children

“…The resulting 390 383 eligible children (the characteristics of this population are described elsewhere 14 ) were then categorized into 6 groups (Fig 1) based on their service use and BH screening in SFY'09: (1) at least 1 BH screen with a "negative" modifier but no positive modifier; (2) at least 1 BH screen with a "positive" modifier; (3) at least 1 BH screen but without any modifiers; (4) children with well-child care but no claim for a BH screen; (5) children with neither well-child visits nor BH screen claims; and (6) children with eligibility but no claims or encounters. Given the nature of the data, we cannot determine whether a screen without a modifier was positive or negative or why the modifier was missing.…”

“…However, in a previous study that examined characteristics of children based on modifiers, we found that children with negative modifiers closely resembled those without modifiers. 14 An index or "salient" screening visit date was assigned to children/youth based on the date of the first negative modifier (for those without positive modifiers, group 1), the first positive modifier (for group 2), and the first use of 96110 for those without any modifiers (group 3). For groups without visits including a screening claim, the first wellchild visit (group 4) or the first claim/ encounter (group 5) were used as the salient visits.…”

“…An earlier article by our group on CBHI used multiple years of data but focused on individual background features rather than outcomes. 14 To date, little is known about whether children who receive screening go on to obtain specialty BH services or what predicts receipt of services. To address this research gap, the current study sought to determine whether screened children, particularly those "newly identified" as having BH issues, received BH services after their screening visits.…”