Abstract
Home and Community-Based Services (HCBS) Medicaid waivers for children increase the availability of public funding for HCBS by waiving or expanding the means tests for parents’ income, basing child eligibility for Medicaid coverage primarily on clinical need. But many states provide mechanisms apart from HCBS waivers to increase coverage for youth with significant mental health needs. Through interviews with public mental health officials from 37 states, this study identifies and explains non-waiver funding strategies for HCBS services for otherwise ineligible youth. Results demonstrate that states expand Medicaid-eligibility through CHIP or use state general revenue funds to pay for medically necessary HCBS for non-Medicaid youth.
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Barbot, B., Bick, J., Bentley, M. J., Balestracci, K. M. B., Woolston, J. L., Adnopoz, J. A., et al. (2015). Changes in mental health outcomes with the intensive in-home child and adolescent psychiatric service: A multi-informant, latent consensus approach. International Journal of Methods in Psychiatric Research. https://doi.org/10.1002/mpr.1477.
Barrilleaux, C. J., & Miller, M. E. (1988). The political economy of state Medicaid policy. The American Political Science Review, 82(4), 1089–1107. https://doi.org/10.2307/1961751.
Barth, R. P., Greeson, J. K., Guo, S., Green, R. L., Hurley, S., & Sisson, J. (2007). Outcomes for youth receiving intensive in-home therapy or residential care: A comparison using propensity scores. American Journal of Orthopsychiatry, 77(4), 497–505. https://doi.org/10.1037/0002-9432.77.4.497.
Center for Behavioral Health Statistics and Quality. (2016). 2014 National Survey on Drug Use and Health: DSM-5 changes: Implications for child serious emotional disturbance (unpublished internal documentation). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DSM5ImpactChildSED-2016.pdf
Cidav, Z., Marcus, S. C., & Mandell, D. S. (2014). Home- and community-based waivers for children with autism: Effects on service use and costs. Intellectual and Developmental Disabilities, 52(4), 239–248. https://doi.org/10.1352/1934-9556-52.4.239.
Cooper, J. L., Aratani, Y., Knitzer, J., Douglas-Hall, A., Masi, R., Banghart, P. L., & Dababnah, S. (2008). Unclaimed children revisited: The status of children’s mental health policy in the United States. Retrieved from http://academiccommons.columbia.edu/catalog/ac:126417
Corliss, B. A., Lawrence, E. C., & Nelson, M. A. (2008). Families of children with serious emotional disturbances: Parent perceptions of family resources and stressors. Child and Adolescent Social Work Journal, 25(4), 271–285. https://doi.org/10.1007/s10560-008-0126-0.
Costello, E. J., Egger, H., & Angold, A. (2005). 10-year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child & Adolescent Psychiatry, 44(10), 972–986. https://doi.org/10.1097/01.chi.0000172552.41596.6f.
Friesen, B. J., Giliberti, M., Katz-Leavy, J., Osher, T., & Pullmann, M. D. (2003). Research in the service of policy change: The “Custody Problem”. Journal of Emotional and Behavioral Disorders, 11(1), 39–47. https://doi.org/10.1177/106342660301100106.
Garcia, A. R., Metraux, S., Chen, C.-C., Park, J. M., Culhane, D. P., & Furstenberg, F. F. (2017). Patterns of multisystem service use and school dropout among seventh-, eighth-, and ninth-grade students. The Journal of Early Adolescence. https://doi.org/10.1177/0272431617714329.
Graaf, G. E. (2018). Keeping kids at home, in school, and out of trouble: Funding home and community-based care for non-medicaid eligible youth with complex behavioral healthcare needs (Ph.D.). University of California, Berkeley, United States – California. Retrieved from https://search-proquest-com.ezproxy.uta.edu/pqdtglobal/docview/2101510568/abstract/C71460FC0B984CC0PQ/1
Graaf, G., & Snowden, L. (2017). The role of Medicaid home and community-based service policies in organizing and financing care for children with severe emotional disturbance. Children and Youth Services Review, 81, 272–283. https://doi.org/10.1016/j.childyouth.2017.08.007.
Graaf, G., & Snowden, L. (2018). Medicaid waivers and public sector mental health service penetration rates for youth. American Journal of Orthopsychiatry, 88(5), 597–607. https://doi.org/10.1037/ort0000295.
Greenbaum, P. E., & Dedrick, R. F. (2007). Changes in use of alcohol, marijuana, and services by adolescents with serious emotional disturbance. A parallel-process growth mixture model. Journal of Emotional and Behavioral Disorders, 15(1), 21–32. https://doi.org/10.1177/10634266070150010301.
Heflinger, C. A., & Taylor-Richardson, K. D. (2004). Caregiver strain in families of children with serious emotional disturbance: Does relationship to child make a difference? Journal of Family Social Work, 8(1), 27–45. https://doi.org/10.1300/J039v08n01_02.
Hill, K. (2017). Prevalence, experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements. Children and Youth Services Review, 74, 62–70. https://doi.org/10.1016/j.childyouth.2017.01.025.
Hoagwood, K. E., Zima, B. T., Buka, S. L., Houtrow, A., & Kelleher, K. J. (2016). State-to-state variation in SSI enrollment for children with mental disabilities: An administrative and ethical challenge. Psychiatric Services, 32, 89. https://doi.org/10.1176/appi.ps.201600118.
Howell, E. M. (2004). Access to children’s mental health services under medicaid and SCHIP (Text). The Urban Institute. Retrieved from http://webarchive.urban.org/publications/311053.html
Ireys, H. T., Pires, S., & Lee, M. (2006). Public financing of home and community services for children and youth with serious emotional disturbances: Selected state strategies. U.S. Department of Health and Human Services. Retrieved from http://www.bazelon.org/News-Publications/Publications/List/1/CategoryID/20/Level/a.aspx?SortField=ProductNumber%2cProductNumber
James, S., Charlemagne, S. J., Gilman, A. B., Alemi, Q., Smith, R. L., Tharayil, P. R., et al. (2010). Post-discharge services and psychiatric rehospitalization among children and youth. Administration and Policy In Mental Health, 37(5), 433–445. https://doi.org/10.1007/s10488-009-0263-6.
January, S.-A. A., Duppong Hurley, K., Stevens, A. L., Kutash, K., Duchnowski, A. J., & Pereda, N. (2016). Evaluation of a community-based peer-to-peer support program for parents of at-risk youth with emotional and behavioral difficulties. Journal of Child and Family Studies, 25(3), 836–844. https://doi.org/10.1007/s10826-015-0271-y.
Jenson, C. E., Turner, W., Amero, S., Johnson, A., & Werrbach, G. (2002). Predicting resource utilization by children with serious emotional disturbance and their families. Journal of Child and Family Studies, 11(3), 361–371.
Kernan, J. B., Griswold, K. S., & Wagner, C. M. (2003). Seriously emotionally disturbed youth: A needs assessment. Community Mental Health Journal, 39(6), 475–486. https://doi.org/10.1023/B:COMH.0000003009.21130.da.
Kernan, J. B., & Morilus-Black, M. (2010). Social supports for youth and families. Community Mental Health Journal, 46(3), 258–264. https://doi.org/10.1007/s10597-009-9266-8.
Kitchener, M., Ng, T., & Harrington, C. (2004). Medicaid 1915(c) home and community-based services waivers: a national survey of eligibility criteria, caps, and waiting lists. Home Health Care Services Quarterly, 23(2), 55–69. https://doi.org/10.1300/J027v23n02_04.
Leitner, J. B., Hehman, E., & Snowden, L. R. (2018). States higher in racial bias spend less on disabled medicaid enrollees. Social Science and Medicine, 1982(208), 150–157. https://doi.org/10.1016/j.socscimed.2018.01.013.
Leslie, D., Iskandarani, K., Dick, A., Mandell, D., Yu, H., Velott, D., et al. (2017). The effects of medicaid home and community-based services waivers on unmet needs among children with autism spectrum disorder. Medical Care, 55(1), 57–63. https://doi.org/10.1097/MLR.0000000000000621.
Lewis, D. C., Schneider, S. K., & Jacoby, W. G. (2015). The impact of direct democracy on state spending priorities. Electoral Studies, 40, 531–538. https://doi.org/10.1016/j.electstud.2015.07.005.
Marcenko, M. O., Keller, T. E., & Delaney, M. A. (2001). Children with SED and their families in an urban public mental health system: Characteristics, needs, and expectations. Journal of Child and Family Studies, 10(2), 213–226.
Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service utilization for lifetime mental disorders in U.S. Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCSA). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45. http://dx.doi.org/10.1016/j.jaac.2010.10.006
Merryman, M. B., Miller, N. A., Shockley, E., Eskow, K. G., & Chasson, G. S. (2015). State adoption of Medicaid 1915(c) waivers for children and youth with Autism Spectrum Disorder. Disability and Health Journal, 8(3), 443–451. https://doi.org/10.1016/j.dhjo.2015.03.003.
Miles, M. B., Huberman, A. M., & Saldaña, J. (2013). Qualitative data analysis: A methods sourcebook (Third ed.). Thousand Oaks, Califorinia: SAGE Publications Inc.
Miller, N. A., & Kirk, A. (2016). Predicting state investment in Medicaid home- and community-based services, 2000–2011. Journal of Aging & Social Policy, 28(1), 49–64. https://doi.org/10.1080/08959420.2016.1111729.
Mordre, M., Groholt, B., Kjelsberg, E., Sandstad, B., & Myhre, A. M. (2011). The impact of ADHD and conduct disorder in childhood on adult delinquency: A 30 years follow-up study using official crime records. BMC Psychiatry. https://doi.org/10.1186/1471-244X-11-57.
Ng, T., Stone, J., & Harrington, C. (2015). Medicaid home and community-based services: How consumer access is restricted by state policies. Journal of Aging & Social Policy, 27(1), 21–46. https://doi.org/10.1080/08959420.2015.969078.
Owens, P., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013.
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y.
Parish, S. L., Thomas, K. C., Williams, C. S., & Crossman, M. K. (2015). Autism and families’ financial burden: The association with health insurance coverage. American Journal on Intellectual and Developmental Disabilities, 120(2), 166–175. https://doi.org/10.1352/1944-7558-120.2.166.
Porche, M. V., Fortuna, L. R., Lin, J., & Alegria, M. (2011). Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Development, 82(3), 982–998. https://doi.org/10.1111/j.1467-8624.2010.01534.x.
Richardson, M., Cobham, V., McDermott, B., & Murray, J. (2013). Youth mental illness and the family: Parents’ loss and grief. Journal of Child and Family Studies, 22(5), 719–736. https://doi.org/10.1007/s10826-012-9625-x.
Romansky, J. B., Lyons, J. S., Lehner, R. K., & West, C. M. (2003). Factors related to psychiatric hospital readmission among children and adolescents in state custody. Pychiatric Services, 54(3), 356–362.
Saldaña, J. (2013). The coding manual for qualitative researchers (p. 2013). Los Angeles, Thousand Oaks, CA: SAGE Publications.
Sheppard, R., Deane, F. P., & Ciarrochi, J. (2017). Unmet need for professional mental health care among adolescents with high psychological distress. Australian & New Zealand Journal of Psychiatry, 2, 59. https://doi.org/10.1177/0004867417707818.
Shepperd, S., Doll, H., Gowers, S., James, A., Fazel, M., Fitzpatrick, R., et al. (2009). Alternatives to inpatient mental health care for children and young people. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006410.pub2.
Snyder, A., Marton, J., McLaren, S., Feng, B., & Zhou, M. (2017). Do high fidelity wraparound services for youth with serious emotional disturbances save money in the long-term? The Journal of Mental Health Policy and Economics, 20(4), 167–175.
Solhkhah, R., Passman, C. L., Lavezzi, G., Zoffness, R. J., & Silva, R. R. (2007). Effectiveness of a children’s home and community-based services waiver program. Psychiatric Quarterly, 78(3), 211–218. https://doi.org/10.1007/s11126-007-9042-2.
Trask, E. V., Fawley-King, K., Garland, A. F., & Aarons, G. A. (2016). Do aftercare mental health services reduce risk of psychiatric rehospitalization for children? Psychological Services, 13(2), 127–132. https://doi.org/10.1037/ser0000043.
Urdapilleta, O., Kim, G., Wang, Y., Howard, J., Varghese, R., Waterman, G., … Palmisano, C. (2013). National evaluation of the medicaid demonstration waiver home- and community-based alternatives to psychiatric residential treatment facilities. Submitted to Disabled and Elderly Health Programs Group Centers for Medicare and Medicaid Services, Contract Number: HHSM-500-2006-00007I, Task Order #2 Final Evaluation Report. IMPAQ Interntional, Inc. Retrieved from http://www.bazelon.org/News-Publications/Publications/List/1/CategoryID/20/Level/a.aspx?SortField=ProductNumber%2cProductNumber
Vanneman, M. E., Snowden, L. R., & Dow, W. H. (2016). Medicaid spending differences for child/youth community-based care in California’s decentralized public mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 1–13. https://doi.org/10.1007/s10488-016-0753-2
Williams, N. J., Scott, L., & Aarons, G. A. (2017). Prevalence of serious emotional disturbance among U.S. children: A meta-analysis. Psychiatric Services, 2, 59. https://doi.org/10.1176/appi.ps.201700145.
Wu, P., Hoven, C. W., Liu, X., Fuller, C. J., Fan, B., Musa, G., … Cook, J. A. (2008). The relationship between depressive symptom levels and subsequent increases in substance use among youth with severe emotional disturbance. Journal of Studies on Alcohol and Drugs, 69(4), 520–527.
Zhu, L., & Clark, J. H. (2015). “Rights without Access” the political context of inequality in health care coverage in the US States. State Politics & Policy Quarterly, 15(2), 239–262. https://doi.org/10.1177/1532440014568569.
Zigmond, N. (2006). Twenty-four months after high school: Paths taken by youth diagnosed with severe emotional and behavioral disorders. Journal of Emotional and Behavioral Disorders, 14(2), 99–107. https://doi.org/10.1177/10634266060140020601.
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Graaf, G., Snowden, L. State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers. Adm Policy Ment Health 46, 530–541 (2019). https://doi.org/10.1007/s10488-019-00933-2
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DOI: https://doi.org/10.1007/s10488-019-00933-2