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Medicaid Expenditures on Psychotropic Medications for Maltreated Children: A Study of 36 States
Ramesh Raghavan, M.D., Ph.D.; Derek S. Brown, Ph.D.; Benjamin T. Allaire, M.A.; Lauren D. Garfield, Ph.D.; Raven E. Ross, M.S.W.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201400028
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Dr. Raghavan, Dr. Brown, Dr. Garfield, and Ms. Ross are with the Brown School, Washington University in St. Louis, St. Louis, Missouri (e-mail: raghavan@wustl.edu). Dr. Raghavan is also with the Department of Psychiatry, Washington University in St. Louis. Mr. Allaire is with RTI International, Research Triangle Park, North Carolina.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Children with histories of abuse or neglect are the most expensive child population to insure for their mental health needs. This study aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for these children.

Methods  Children (N=4,445) participating in the National Survey of Child and Adolescent Well-Being (NSCAW) and from households under investigation for suspected child abuse and neglect were linked to their Medicaid claims from 36 states. Expenditures on psychotropic medications between the NSCAW sample and a propensity score–matched comparison sample of Medicaid-enrolled children were compared in a two-part regression of logistic and generalized linear models.

Results  Children in the NSCAW sample had twice the odds of psychotropic drug use and $190 higher mean annual expenditures on psychotropic drugs than children 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 (CBCL) 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 CBCL to identify and treat high-need children.

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Table 1Utilization rate and mean psychotropic expenditures among maltreated and nonmaltreated youths, by type of medicationa
Table Footer Note

a nT=9,402 child-year observations. Utilization is the row mean and is nonexclusive, so the sum may exceed the Medicaid drug claims file (MRX) or Red Book total. Expenditures reflect means for observations of children using a particular type of medication. Zeroes are not included in the means.

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b NSCAW, National Survey of Child and Adolescent Well-Being. Participants are children and adolescents who have come into contact with child welfare agencies.

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Table 2Cumulative Medicaid drug expenditures (MRX classification) among youths participating in the NSCAW and a comparison samplea
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a NSCAW, National Survey of Child and Adolescent Well-Being. nT=9,402 child-year observations. All models included state and year dummy variables (not shown) to control for state Medicaid differences and time trends. All insurance categories in the model included full behavioral health coverage.

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b Reflects both differences in the likelihood of use of (part 1) and levels of expenditure on (part 2) psychotropic drugs

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c Generalized linear model coefficient

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d Primary care case management

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Table 3Cumulative drug expenditures (MRX classification) among National Survey of Child and Adolescent Well-Being participants onlya
Table Footer Note

a nT=3,520 child-year observations. All models include state and year dummy variables (not shown) to control for state Medicaid differences and time trends. All insurance categories in the model include full behavioral health coverage.

Table Footer Note

b Reflects both differences in the likelihood of use of (part 1) and levels of expenditure on (part 2) psychotropic drugs

Table Footer Note

c Generalized linear model coefficient

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d Primary care case management

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