Utilization of Medicaid mental health services by nondisabled children and adolescents

OBJECTIVE: Mental health service use and costs for nondisabled children and adolescents in the Medicaid programs of Michigan and Tennessee were examined to improve understanding of patterns of service use in this population. METHODS: Data from the Medicaid Analysis Project for States, sponsored by the Health Care Financing Administration, were examined for nondisabled children and adolescents under 19 years of age who were continuously enrolled in Medicaid in 1990 and who received Medicaid mental services, including treatment for alcohol and drug abuse. Recipients of mental health services constituted 5 and 7 percent of the nondisabled children and adolescents in the Medicaid programs in Michigan and Tennessee, respectively. RESULTS: Total expenditures for mental health care recipients were three or more times higher than the level suggested by their proportion in the general Medicaid nondisabled population. Their psychiatric hospitalizations were much longer, with mean lengths of stay of 44 days in Tennessee and 60 in Michigan. Although inpatient utilization rates were similar in the two states, outpatient utilization differed by type of problem treated, provider, and type of treatment. About a third of mental health recipients received psychotropic drugs; cerebral stimulants were the most commonly prescribed type. CONCLUSIONS: Results illustrate the need to learn more about Medicaid mental health services for younger children and the use of psychotropic drugs. They also suggest that states reforming their Medicaid programs to contain costs should pay particular attention to the use of mental health services by children and adolescents.