Medicaid expenditures on psychotropic medications for maltreated children

A study of 36 states

Ramesh Raghavan, Derek S. Brown, Benjamin T. Allaire, Lauren D. Garfield, Raven E. Ross

    Research output: Contribution to journalArticle

    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.

    Original languageEnglish (US)
    Pages (from-to)1445-1451
    Number of pages7
    JournalPsychiatric Services
    Volume65
    Issue number12
    DOIs
    StatePublished - Dec 1 2014

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    Medicaid
    Health Expenditures
    Child Welfare
    Psychotropic Drugs
    Antimanic Agents
    Child Abuse
    Case Management
    Child Behavior
    Checklist
    Antidepressive Agents
    Primary Health Care
    Fee-for-Service Plans
    Propensity Score
    Cost Control
    Linear Models
    Mental Health
    Logistic Models
    Surveys and Questionnaires

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Raghavan, R., Brown, D. S., Allaire, B. T., Garfield, L. D., & Ross, R. E. (2014). Medicaid expenditures on psychotropic medications for maltreated children: A study of 36 states. Psychiatric Services, 65(12), 1445-1451. https://doi.org/10.1176/appi.ps.201400028

    Medicaid expenditures on psychotropic medications for maltreated children : A study of 36 states. / Raghavan, Ramesh; Brown, Derek S.; Allaire, Benjamin T.; Garfield, Lauren D.; Ross, Raven E.

    In: Psychiatric Services, Vol. 65, No. 12, 01.12.2014, p. 1445-1451.

    Research output: Contribution to journalArticle

    Raghavan, R, Brown, DS, Allaire, BT, Garfield, LD & Ross, RE 2014, 'Medicaid expenditures on psychotropic medications for maltreated children: A study of 36 states', Psychiatric Services, vol. 65, no. 12, pp. 1445-1451. https://doi.org/10.1176/appi.ps.201400028
    Raghavan, Ramesh ; Brown, Derek S. ; Allaire, Benjamin T. ; Garfield, Lauren D. ; Ross, Raven E. / Medicaid expenditures on psychotropic medications for maltreated children : A study of 36 states. In: Psychiatric Services. 2014 ; Vol. 65, No. 12. pp. 1445-1451.
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