New Reports Shed Light on Medicaid and Child Mental Health

We at CCF are doing more to uncover whether children are getting the services they need in Medicaid and CHIP to ensure school readiness and put them on the path to thrive in adulthood. Many Say Ahhh! readers know that it can be tricky to fully understand the exact services covered by Medicaid in each state given the wide variation of approaches states can take, including the many pathways to ensuring children receive the full range of services they are entitled to receive under Medicaid’s EPSDT benefit.

As our friends at ZERO TO THREE explained earlier this year, promoting infant and early childhood mental health is one of the key ways to lay a strong foundation for children’s health over the long run. And unlike the patient-driven traditional health service models, early childhood mental health services actively involve parents and caregivers and provide a strong preventive services lens, with the intent of building strong protective factors for children through their earliest experiences.

A new report by the National Center for Children in Poverty provides a helpful map of Medicaid support for children’s mental health. Using Medicaid to Help Young Children and Parents Access Mental Health Services, a survey of state Medicaid officials in 48 states and D.C., uncovered how Medicaid pays for mental health services for young children in a variety of settings. In sum:

  • Most states cover ECMH services in the home (46 states), ECMH in a primary practice setting (45), care coordination (44), child social-emotional screening (41), dyadic/parent-child treatment (38), and ECMH in an early care and education setting (34). Fewer than one third of states that reimburse defined services require evidence-based practices. Helpful state maps that show where each state stands on the identified services are included in the report.
  • Fewer states cover maternal depression screening (9) or parenting programs (12) under the child’s Medicaid number as a means to address children’s mental health needs. The authors aimed to specify screening tools for maternal depression or social-emotional screening reimbursement.

The report also highlights a frequent challenge we encounter: difficulty tracking delivery of specific services, which is often due to a lack of separate billing codes for many services. The insufficient data makes it tough to analyze gaps between policy and practice. (An earlier piece by the Center for Health Care Strategies looks at children’s mental health services utilization in Medicaid using 2005 data, but not by state.) The authors recommend using the report as a conversation starter with state Medicaid and children’s mental health agencies to identify new opportunities to improve services and better understand how children are being served in practice under current policies.

Another new study, this time from the Journal of Behavioral Health Services & Research, surveyed state children’s mental health directors, many of whom are in the same agency as Medicaid, but do not often have clear budget authority over funding for children’s mental health services. While the authors cite progress on elevating children’s mental health, survey respondents noted many new opportunities and challenges in doing more for children. The following excerpt presents the perspectives of two children’s mental health directors and sums up many of the challenges we often face serving children in Medicaid:

“In addition to inadequate funds and unequal allocation of resources, the current structure also creates concern that the unique needs of children will be ignored. One respondent, for example, explained that, “The state makes changes to children’s and adult mental health programs at the same time, and it is difficult to make sure that policy makers understand the different needs in children’s services.” Another added, “Funding of children’s mental health is based on an adult Medicaid service delivery model, which at times stifles creativity and where services can occur.”

As we’ve heard elsewhere, this challenge of addressing the unique needs of children in the health system is by no means limited to mental health. These reports offer new information to help child health advocates and other stakeholders work with their state agency partners on policy solutions to fulfill the promise of Medicaid and the ACA.

Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.