Assessing the impacts of Medicaid Home and Community Based Waivers for children with Severe Emotional Disturbance

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PROJECT SUMMARY The overall goal of this K01 application is to estimate the impact of 1915(c) Home and Community-Based Services (HCBS) Medicaid waiver programs for children with Severe Emotional Disturbance (SED) on behavioral health care service use and expenditures for children with SED. Children with severe SED are at significant risk for psychiatric long-term care (LTC) use due to the severity of their symptoms and inability to access alternative community-based behavioral health care. To reduce public financial burdens and family distress associated with use of psychiatric LTC, one in five states offer 1915(c) HCBS Medicaid waiver policies. These policies expand the Medicaid-funded community-based service array for children who exhibit a clinical need for institutional psychiatric care, regardless of family income levels. Though these policies are intended to prevent psychiatric LTC use by providing alternative community-supports, achievement of these goals is unclear. Scant existing research lacks either causal inference or generalizability, as they are cross sectional, regional, or minimally control for clinical variation in program participants. The goal of this K01 is to train the recipient in the statistical and methodological skills needed to study the impacts of health policy on service utilization and expenditure outcomes for children and youth with complex behavioral health needs. Research aims are to 1) create a comprehensive SED waiver policy dataset that codifies the structures and provisions of these policies across states and over time, 2) identify and compare characteristics of children enrolled in SED waiver programs and children who use psychiatric LTC among Medicaid-enrolled children with behavioral health disorders; 2b) assess SED waiver policies and waiver program enrollment’s association with amelioration of adverse risk factors for LTC, and 3) estimate the effects of the Texas SED Waiver and its characteristics on Medicaid-reimbursed behavioral health service use and expenditures. The training aims of the project are to 1) acquire knowledge, skill, and experience in public health law research methods, 2) build knowledge on the assumptions and applicability of research designs and statistical methods for estimating causal effects of behavioral health policy interventions using observational and administrative data, 3) apply current and best practices for defining and measuring behavioral health service use and expenditures using diverse sources of health claims data and 4) obtain the research, writing, and administrative expertise to submit a successful R01 grant during the final year of the K01. Training aims will be accomplished through formal coursework, individualized instruction, seminar and workgroup participation, mentored research, and conference participation. Research aims will use data from state SED waiver applications merged with Medicaid claims data from state and federal resources. This project will provide novel evidence for policymakers nationwide regarding which children may be at risk for psychiatric institutional care, the policy or service interventions that may reduce these risks, and what costs may be associated with these interventions.