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Gaps in Medicaid coverage negatively affect pediatric mental health care

BALTIMORE — Children who experienced gaps in Medicaid coverage were less likely to be prescribed psychotropic or antipsychotic treatment or receive psychosocial therapy, according to data presented at the Pediatric Academic Societies Meeting.

“It is critical for children with mental disorders to be managed by a combination of medication and psychosocial therapy. In addition, continuous insurance coverage is an important component for effective management of these patients,” John Myers, MSPH, PhD, of the University of Louisville, Kentucky, and colleagues wrote. “An evaluation of the impact insurance gaps has on Medicaid children being appropriately prescribed medications and receiving psychosocial therapy is understudied.”

John Myers

To determine predictors of gaps in insurance coverage and the impact of these gaps on children receiving Medicaid, researchers analyzed Kentucky Medicaid records for 2012 to 2014 among children aged 1 to 17 years (n = 604,665). They defined an enrollment gap as a discontinuity of enrollment for greater than 45 consecutive days between periods.

Overall, 78.8% of children had no gaps in insurance coverage.

Children in foster care (OR = 1.18; 95% CI, 1.1-1.3; P < .001), children younger than age 12 years (OR = 1.05; 95% CI, 1.01-1.11; P < .001) and females (OR = 1.07; 95% CI, 1.02-1.13; P < .001) were significantly more likely to be continuously enrolled.

Children with gaps in coverage were less likely to be prescribed psychotropic medication (OR = 0.48; 95% CI, 0.44-0.52; P < .001), an antipsychotic (OR = 0.37; 95% CI, 0.29-0.49; P < .001), or receive advocated psychosocial therapy (OR = 0.67; 95% CI, 0.62-0.72; P < .001).

Children prescribed a psychotropic or antipsychotic medication were less likely to receive advocated metabolic monitoring if they experienced gaps in coverage (OR = 0.53; 95% CI, 0.42-0.58; P < .001).

“Gaps in insurance coverage may have detrimental impacts for managing Medicaid children with mental disorders,” the researchers wrote. “Gaps in coverage led to less prescribing of medication and less psychosocial therapy being employed, which has been well established to be beneficial. In addition, advocated follow-up (metabolic monitoring) is detrimentally impacted. Establishing ways to decrease gaps in insurance coverage is needed.” – by Amanda Oldt

Reference:

Myers J, et al. Effects of gaps in insurance coverage on Medicaid children prescribed psychotropic medication. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

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