Abstract
Examine the impact of Colorado's Medicaid mental health carve-out program on children in child welfare and juvenile justice systems. Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used to estimate a two-part model of inpatient, outpatient, and residential treatment center utilization, controlling for patient characteristics. The study finds that juvenile justice and child welfare populations were more strongly affected by managed care than the general youth population, regarding reduced utilization of inpatient and outpatient services. Increases in Residential Treatment Centers use were greater for juvenile justice than either the child welfare sample or the total sample. Youth in child welfare increase utilization of outpatient services. Most utilization effects are stronger for not-for-profit than for-profit managed care organizations. The experience of Colorado implies that a mental health carve-out affects patterns of care for youth and differentially so for youth in juvenile justice and child welfare systems. Controlling for population characteristics, the effects are stronger for not-for-profit than for-profit managed care organizations.
Similar content being viewed by others
REFERENCES
American Psychiatric Association, Washington, DC. (1987). US Diagnostic and Statistical Manual of Mental Disorders (3rd ed. revised). American Psychiatric Association: Washington, DC, pp. xxix, 567.
Bloom, J. R., Hu, T.-W., Wallace, N. T., Cuffel, B., Hausman, J., & Scheffler, R. M. (1998). Mental health costs and outcomes under alternative capitation systems in Colorado: Early results. Journal of Mental Health Policy and Economics, 1(1), 1–11.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14(3), 147–159.
Burns, B., Teagle, S., Schwartz, M., Angold, A., & Holtzman, A. (1999). Managed behavioral health care: A medicaid carveout for youth. Health Affairs, 18, 214–225.
Burns, B. J., Thompson, J., & Goldman, H. (1993). Initial treatment decisions by level of care for youth in the CHAMPUS tidewater demonstration. Admin Policy Mental Health, 20, 231–246.
Catalano, R., Libby, A. M., Snowden, L. R., & Cuellar, A.E. (2000). The effect of capitation financing on mental health services for children and youth: The Colorado experience. American Journal of Public Health, 90(12), 1861–1865.
Chernoff, R., Combs-Orme, T., Risley-Curtiss, C., & Heisler, A. (1994). Assessing the health status of children entering foster care. Pediatrics, 93(4), 594–601.
Christianson, J. B., Manning, W., Lurie, N., Stoner, T., Gray, D. Z., Popkin, M. K., & Marriott, S. (1995). Utah's prepaid mental health plan: The first year. Health Affairs, 14, 160–172.
Combs-Orme, T., Chernoff, R.G., & Kager, V.A. (1991). Utilization of health care by foster children: Application of a theoretical model. Children and Youth Services Review, 13(12), 113–129.
Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., Erkanli, A., et al. (1996). The great smoky mountains study of youth. Goals, design, methods, and the prevalence of DSMIII-R disorders. Archives of General Psychiatry, 53(12), 1129–1136.
Duan, N. (1983). Smearing estimate: A nonparametric retransformation method. Journal of the American Statistical Association, 78, 605–610.
Duan, N., Manning, W. G., Morris, C. N., & Newhouse, J. P. (1984). Choosing between the sample selection model and the multipart model. Journal of Business and Economic Statistics, 1, 283–89.
Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children's mental health across one year. Community Mental Health Journal, 35(1), 31–46.
Frank, R. G., McGuire, T. G., & Newhouse, J. P. (1995). Risk contracts in managed mental health care. Health Affairs, 18(5), 214–225.
Freund, D., & Lewit, E. (1993). Managed care for children and pregnant women. Future of Children, 3, 92–122.
Friedman, R., Silver, S., Duchnowski, A., et al., (1987). Characteristics of children with serious emotional disturbances identified by public systems as requiring services. Tampa: Florida Mental Health Institute, University of South Florida.
Halfon, N., Berkowitz, G., & Klee, L. (1992a). Children in foster care in California: An examination of Medicaid reimbursed health services utilization. Pediatrics, 89, 1230–1237.
Halfon, N., Berkowitz, G., & Klee, L. (1992b). Mental health service utilization by children in foster care in California. Pediatrics, 89, 1238–1244.
Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953–961.
Henggeler, W., Melton, G., Smith, L., Schoenwald, S., & Hanley, J. (1993). Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2, 283–293.
Henggeler, S.W., Schoenwald, S. I. C., & Pickrel, S. G. (1994). The contribution of treatment outcome research to the reform of children's mental health services: Multisystemic therapy as an example. Journal of Mental Health Administration, 21(3), 229–239.
Manning, W. G., Wells, K. B., & Benjamin, B. (1986). Use of outpatient mental health care: Trial of a prepaid group practice versus fee for service (R-3277-NIMH). Santa Monica, CA: Rand Corporation.
McCabe, K., Yeh, M., Hough, R., Landsverk, J., Hurlburt, M., Culver, S., & Reynolds, B. (1999). Racial/ethnic representation across five public sectors of care for youth. Journal of Emotional and Behavioral Disorders, 7(2), 72–82.
National Academy of State Health Policy. (1997). Medicaid managed care: A guide for states (3rd ed.). Portland, ME: National Academy of State Health Policy.
Nicholson, J., Young, S., Simon, L., Bateman, A., & Fisher, W. (1996). Impact of Medicaid managed care on child and adolescent emergency mental health screening in Massachusetts. Psychiatric Services, 47, 1344–1350.
Norton, E. C., Lindrooth, R., & Dickey, B. (1997a). Cost shifting in a managed care plan. Chapel Hill, NC: University of North Carolina at Chapel Hill.
Norton, E. C., Lindrooth, R., & Dickey, B. (1997b). Cost shifting in a mental health carve-out for the AFDC population. Health Care Financing Review, 18, 95–108.
Patrick, D., Libby, A. M., & Coen, A. (1997). Community mental health services for youth in Colorado: Changes and services since the implementation of medicaid capitation. Berkeley, CA: Center for Mental Health Services Research, University of California.
Rosenblatt, J. A., Rosenblatt, A., & Biggs, E. E. (2000). Criminal behavior and emotional disorder: Comparing youth served by the mental health and juvenile justice systems. The Journal of Behavioral Health Services and Research, 27, 227–237.
Scholle, S., Kelleher, K., Childs, G., Medlehoff, J., & Garnder, W. (1997). Changes in Medicaid managed care enrollment among children. Health Affairs, 16, 164–170.
Stroul, B., & Pires, S. (1997). State health care reforms: How they affect children and adolescents with emotional disorders and their families. Journal of Mental Health Administration, 24, 386–399.
Stroul, B. A., Pires, S. A., Armstrong, M. I., & Meyers, J. C. (1998). The impact of managed care on mental health services for children and their families. The Future of Children, 8(2), 119–133.
Takayama, J., Bergman, A., & Connell, F. (1994). Children in foster care in the State of Washington. Health care utilization and expenditures. JAMA, 271(23), 1850–1855.
Trupin, E. W., Tarico, V. S., Low, B. P., Jemelka, R., et al. (1993). Children on child protective service caseloads: Prevalence and nature of serious emotional disturbance. Child Abuse and Neglect, 17(3), 345–355.
Vander Stoep, A., Evens, C., & Taub, J. (1997). Risk of juvenile justice system referralamongchildren in a public mental health system. Journal of Mental Health Administration, 24, 428–442.
Zhang, M., Lancaster, B., Clardy, J., & Smith, G. (1999). Mental health capitation for children and adolescents under Medicaid. Psychiatric Services, 50, 189–191.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cuellar, A.E., Libby, A.M. & Snowden, L.R. How Capitated Mental Health Care Affects Utilization by Youth in the Juvenile Justice and Child Welfare Systems. Ment Health Serv Res 3, 61–72 (2001). https://doi.org/10.1023/A:1011507117644
Issue Date:
DOI: https://doi.org/10.1023/A:1011507117644