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

项目摘要 大多数有特殊卫生保健需要的儿童（CSHCN）都有行为健康状况。种族 和少数民族CSHCN更有可能有这些健康状况， 与其他CSHCN的诊断和治疗相比。在获得护理方面的差异导致了在以下方面的差异： 行为健康治疗的使用和保险不足导致CSHCN的健康结果不佳。 行为健康状况的早期识别和治疗对于支持健康和福祉至关重要 在他们的一生中。然而，CSHCN的许多种族和少数民族家庭面临挑战， 获取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： 扩大保险覆盖面，鼓励使用治疗。在生命早期解决这些机制是 这对减少整个生命过程中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距，有各种证据， 一些研究甚至发现，种族和民族的差距，在覆盖面和卫生服务的使用增加后， 最近的医疗保险扩张。其他政策，包括医疗补助的简化或自动登记， 已被证明可以增加医疗补助的入学率，保留率和整体保险覆盖率，但 没有证据表明这些政策对种族/族裔少数群体的覆盖率或利用率方面的差异产生了影响 CSHCN或CSHCN有精神健康状况的人。在扩大服务方面采取有针对性的干预措施， 更有效地减少这些人口的差距，但有证据表明有针对性的干预措施的效果 是有限的。需要更多的研究来了解有针对性的政策在多大程度上可以减少差距 在健康保险覆盖率和行为卫生保健利用的种族/少数民族CSHCN。 这项研究将检查有针对性的干预措施的效果，以增加保险覆盖面， 少数民族和种族CSHCN的行为卫生服务利用：自动登记 通过补充安全收入（SSI）的医疗补助。我们提出了两个互补的分析方法，一个 一个是全国代表性的调查数据，另一个是利用医疗补助索赔数据的自然实验。我们 将量化通过SSI自动登记医疗补助对保险覆盖范围差异的影响， 少数种族和少数民族CHSCN中的行为健康服务使用;确定CSHCN的人口统计学资料 由于自动登记政策而新加入医疗补助计划的人，并检查 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， 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演变。我们的发现将提供 关于有针对性的医疗补助自动登记如何改善行为健康结果的重要见解 这将有助于更广泛地了解如何减少行政管理 负担可能会改善健康公平的弱势和服务不足的CSHCN。

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.