Reducing Behavioral Health Disparities among Children with Special Needs: The Role of Medicaid Automatic Enrollment

减少有特殊需要的儿童的行为健康差异：医疗补助自动注册的作用

基本信息

批准号：
10527597
负责人：
Stephanie Rennane
金额：
$ 64.1万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10527597
关键词：
Address Affect Attention deficit hyperactivity disorder Black Populations Black race Caring Characteristics Child Child Mental Health Child Welfare Data Desire for food Diagnosis Disadvantaged Documentation Early Intervention Early identification Early treatment Eligibility Determination Enrollment Family Health Health Benefit Health Insurance Health Services Health Services Accessibility Health Status Healthcare Hispanic Home Hospitalization Insurance Insurance Coverage Intervention Latino Latino Population Life Life Cycle Stages Long-Term Effects Low income Medicaid Medical Mental Depression Mental Health Mental Health Services Natural experiment Outcome Policies Population Privatization Process Reduce health disparities Reporting Research Risk Role Running Services Source Supplemental Security Income Surveys Time Underinsured Underserved Population Variant Work autism spectrum disorder behavioral health beneficiary care coordination demographics disadvantaged population disparity reduction ethnic minority experience experimental study health care availability health care service utilization health disparity health equity health outcome disparity health service use improved insight insurance plan lower income families medically underserved minority children programs racial and ethnic racial and ethnic disparities racial minority

项目摘要

PROJECT SUMMARY A majority of children with special health care needs (CSHCN) have behavioral health conditions. Racial and ethnic minority CSHCN are more likely to have these health conditions and less likely to have them diagnosed and treated compared with other CSHCN. Disparities in access to care contribute to disparities in use of behavioral health treatment, and inadequate insurance leads to poor health outcomes among CSHCN. Early identification and treatment for behavioral health conditions is critical to support the health and well-being of CSHCN over their lifetimes. Yet, many racial and ethnic minority families of CSHCN experience challenges in accessing needed behavioral health services. Disparities in behavioral health outcomes can be mitigated by expanding insurance coverage and encouraging use of treatment. Addressing these mechanisms early in life is critical to mitigate health disparities over the entire life course. There is mixed evidence on the extent to which general insurance expansions reduce disparities, and some studies even find that racial and ethnic disparities in coverage and health service use increased after recent health insurance expansions. Other policies, including streamlined or automatic enrollment in Medicaid, have been shown to increase Medicaid enrollment, retention and overall insurance coverage rates, but there is no evidence about the impact of these policies on disparities in coverage or utilization for racial/ethnic minority CSHCN, or CSHCN who have mental health conditions. Targeted interventions in expanding services may be more effective at reducing disparities for these populations but evidence on the effects of targeted interventions is limited. More research is needed to understand the extent to which targeted policies can reduce disparities in health insurance coverage and behavioral health care utilization among racial/ethnic minority CSHCN. This study will examine the effects of a targeted intervention to increase insurance coverage and behavioral health service utilization among racial and ethnic minority CSHCN: automatic enrollment in Medicaid via Supplemental Security Income (SSI). We propose two complementary analytic approaches, one with nationally representative survey data and one exploiting a natural experiment in Medicaid claims data. We will quantify the effects of Medicaid automatic enrollment via SSI on disparities in insurance coverage and behavioral health service use among racial and ethnic minority CHSCN; identify the demographics of CSHCN who are newly enrolled in Medicaid due to automatic enrollment policies and examine potential disparities in their health needs; and examine how the effects on behavioral health service use, health outcomes, and disparities in service use and outcomes evolve over time for newly enrolled CSHCN. Our findings will provide critical insights about how targeted Medicaid automatic enrollment could improve behavioral health outcomes for this underserved population and will contribute to broader understanding of how reducing administrative burden may improve health equity for disadvantaged and underserved CSHCN.

项目概要大多数有特殊医疗保健需求的儿童 (CSHCN) 都有行为健康问题。种族少数族裔 CSHCN 更有可能患有这些健康状况，而不太可能有这些健康状况与其他 CSHCN 的诊断和治疗相比。获得护理方面的差异导致了护理方面的差异使用行为健康治疗和保险不足会导致 CSHCN 的健康状况不佳。早期识别和治疗行为健康状况对于支持健康和福祉至关重要 CSHCN 一生的经历。然而，CSHCN的许多种族和族裔家庭面临着挑战获得所需的行为健康服务。行为健康结果的差异可以通过以下方式缓解：扩大保险覆盖范围并鼓励使用治疗。在生命早期解决这些机制是对于缩小整个生命周期的健康差距至关重要。关于一般保险扩张在多大程度上减少了差异的证据不一，并且一些研究甚至发现，在医疗服务覆盖范围和使用方面的种族和族裔差异在最近的健康保险扩张。其他政策，包括简化或自动注册医疗补助，已被证明可以提高医疗补助的注册率、保留率和总体保险覆盖率，但没有证据表明这些政策对少数种族/族裔覆盖或利用差异的影响 CSHCN，或有心理健康问题的 CSHCN。扩大服务范围的有针对性的干预措施可能是在减少这些人群的差异方面更有效，但有针对性的干预措施效果的证据是有限的。需要更多的研究来了解有针对性的政策可以在多大程度上减少差距少数民族 CSHCN 的健康保险覆盖率和行为医疗保健利用情况。这项研究将检验有针对性的干预措施对增加保险覆盖范围和少数民族行为健康服务利用情况 CSHCN：自动登记通过补充保障收入 (SSI) 获得医疗补助。我们提出两种互补的分析方法，一种具有全国代表性的调查数据和利用医疗补助索赔数据中的自然实验的数据。我们将量化通过 SSI 自动加入医疗补助对保险范围差异的影响，以及少数种族和族裔 CHSCN 的行为健康服务使用情况；确定 CSHCN 的人口统计数据由于自动注册政策而新加入医疗补助的人，并检查潜在的差异他们的健康需求；并研究如何影响行为健康服务的使用、健康结果和对于新注册的 CSHCN，服务使用和结果的差异随着时间的推移而变化。我们的研究结果将提供关于有针对性的医疗补助自动注册如何改善行为健康结果的重要见解为这一服务不足的人群提供服务，并将有助于更广泛地了解如何减少行政管理负担可能会改善弱势群体和服务不足的 CSHCN 的健康公平。