STRENGTHENING MEDICAID-FUNDED MENTAL HEALTH COVERAGE FOR CHILDREN IN CHILD WELFAR

摘要 儿童福利系统中的儿童享有医疗补助的权利，而且是保险费用最高的。 以满足他们的心理健康需求。尽管知道这些儿童的保险费用很高，但医疗补助机构 几乎没有关于哪些儿童特征与支出相关的实证政策指导，什么是 这些支出的数额是在他们在福利系统停留的时间内，以及以下方面的影响 医疗补助政策，可以在控制成本的同时确保获得服务。这种信息赤字有 导致医疗补助预算是根据权宜之计而不是适当性来确定的，以及 这影响了医疗补助机构减少受虐待者心理健康不平等的能力 孩子们。 在儿童福利研究领域，这个研究小组的成员第一次集结了一个 独特的数据集，将全国儿童接触儿童调查的受访者联系起来 福利机构(全国儿童和青少年幸福感调查[NSCAW])对他们的医疗补助申请数据 (医疗补助分析摘录)，以及有关其所在县的医疗补助和精神健康政策的信息 居住地(来自儿童福利机构关爱儿童[CCCW])。这种联系结合了丰富的 调查数据中包含的人员级别信息--例如使用以下方法确定的精神健康服务需求 标准化心理测量方法--使用索赔数据中包含的使用和支出信息。县- 有关政策的级别信息允许检查医疗补助政策在管理方面的有效性 支出，同时控制需求。 对这个唯一构造的数据集的纵向数据分析将(1)建模 儿童需要的各个领域，以及儿童层面的精神卫生服务利用和支出 NSCAW儿童；(2)估计儿童时期的精神卫生服务利用和支出轨迹 发展周期(0-18岁)；和(3)检查针对儿童的医疗补助政策的有效性 关于精神卫生服务利用和支出的福利，以及使用和支出轨迹。 这些具体目标与AHRQ的几个资金优先事项是一致的，包括儿童健康 保险研究倡议，将儿童作为优先人口的战略计划，以及AHRQ的 强调低收入人口和消除贫富差距。这项由一位新调查员提出的建议 -前AHRQ学位论文获得者-汇集了一支经验丰富的高级调查团队和 一位州医疗补助政策制定者，在精神病学方面拥有相当多的集体研究和实践专长，儿童 福利和心理健康服务研究、健康和心理健康经济学和计量经济学，以及 医疗补助计划声称，数据分析可以为高度脆弱的人群回答这些突出的问题。

Abstract Children in the child welfare system possess entitlements to Medicaid, and are the most expensive to insure for their mental health needs. Despite knowing that these children are expensive to insure, Medicaid agencies have little empirical policy guidance on what child characteristics are associated with expenditures, what the magnitude of these expenditures are over the duration of their stay in the welfare system, and the effects of Medicaid policies that can assure access to services while containing costs. This information deficit has resulted in Medicaid budgets being determined on the basis of expediency rather than appropriateness, and this has affected the ability of Medicaid agencies to reduce mental health inequalities among maltreated children. For the first time in the field of child welfare research, members of this research team are assembling a unique data set that links the respondents of a national survey of children coming into contact with child welfare agencies (National Survey of Child and Adolescent Well-Being [NSCAW]) to their Medicaid claims data (Medicaid Analytic Extract), along with information on Medicaid and mental health policies within their counties of residence (from the Caring for Children in Child Welfare [CCCW]). Such a linkage combines the richness of person-level information contained in survey data - such as need for mental health services identified using standardized psychometric measures - with use and expenditure information contained in claims data. County- level information about policies allows the examination of the effectiveness of Medicaid policies in managing expenditures, while controlling for need. Longitudinal data analysis on this uniquely constructed data set will (1) model relationships between various domains of child need, and child-level mental health service utilization and expenditures among NSCAW children; (2) estimate mental health service utilization and expenditure trajectories over the childhood development cycle (ages 0- 18); and (3) examine effectiveness of Medicaid policies targeted at children in child welfare on mental health service utilization and expenditures, and use and expenditure trajectories. These specific aims are consonant with several of AHRQ's funding priorities, including the Child Health Insurance Research Initiative, the Strategic Plan that focuses on children as a priority population, and AHRQ's emphasis on low-income populations and on the elimination of disparities. This proposal by a new investigator - a former AHRQ dissertation grantee - brings together a highly experienced team of senior investigators and a state Medicaid policymaker, with considerable collective research and practice expertise in psychiatry, child welfare and mental health services research, health and mental health economics and econometrics, and Medicaid claims data analysis to answer these salient questions for a highly vulnerable population.