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

项目总结 大多数有特殊卫生保健需求(CSHCN)的儿童都有行为健康状况。种族 和少数民族CSHCN更有可能患有这些健康状况，而不太可能患有这些健康状况 诊断和治疗与其他CSHCN的比较。在获得护理方面的差距导致了 行为健康治疗的使用和保险不足导致CSHCN的健康结局较差。 行为健康状况的早期识别和治疗是支持健康和福祉的关键 CSHCN在他们的一生中。然而，CSHCN的许多种族和少数民族家庭面临着挑战 在获得所需的行为健康服务方面。行为健康结果的差异可以通过以下方式来缓解 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 对于缓解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缩小差距，证据不一。 一些研究甚至发现，种族和民族在覆盖率和卫生服务使用方面的差异在 最近的医疗保险扩张。其他政策，包括简化或自动登记医疗补助， 已经被证明提高了医疗补助的参保率、保留率和总体保险覆盖率，但有 没有证据表明这些政策对种族/少数民族的覆盖面或利用方面的差距产生了影响 CSHCN，或有精神健康问题的CSHCN。扩大服务的有针对性的干预措施可能是 在缩小这些人群的差距方面更有效，但有针对性干预效果的证据 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的医疗保险覆盖率和行为卫生保健利用情况。 这项研究将审查有针对性的干预措施的效果，以增加保险覆盖面和 CSHCN少数民族人群行为卫生服务利用情况：自动登记 通过补充保障收入(SSI)提供的医疗补助。我们提出了两种互补的分析方法，一种 具有全国代表性的调查数据和一项利用医疗补助索赔数据中的自然实验。我们 将量化通过SSI自动登记的Medicaid对保险覆盖范围和 CHSCN少数民族人群行为卫生服务使用情况；确定CSHCN的人口学特征 由于自动登记政策而新参加医疗补助的人，并检查潜在的 他们的健康需求；并检查对行为健康服务使用、健康结果和 新加入的CSHCN在服务使用和结果方面的差异会随着时间的推移而变化。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关键见解 并将有助于更广泛地了解如何减少行政管理 负担可能会改善处境不利和服务不足的CSHCN的健康公平。

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.