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Mental health care utilization and expenditures by children in foster care
J S Harman1, G E Childs, K J Kelleher
1University of Pittsburgh School of Medicine, 3811 O'Hara St, Suite 430, Pittsburgh, PA 15213, USA. harmanjs@msx.upmc.edu
Insights
Children in foster care exhibit significantly higher rates of mental health diagnoses and service utilization compared to other Medicaid recipients. Their mental health care needs and expenditures are comparable to those of children with disabilities.
Area of Science:
- Child Health Services
- Mental Health Services Research
- Health Services Administration
Background:
- Children in foster care often face complex health and behavioral challenges.
- Understanding their mental health service needs is crucial for effective care.
- Comparison with other vulnerable populations, like children with disabilities, provides valuable context.
Purpose of the Study:
- To determine the prevalence of mental health diagnoses in children in foster care.
- To compare mental health service utilization and expenditures for children in foster care versus other Medicaid-eligible children.
- To assess if these patterns differ for children with disabilities.
Main Methods:
- Analysis of Medicaid claims and eligibility data from southwestern Pennsylvania (FY 1995).
- Inclusion of 39,500 children aged 5-17 continuously eligible for Medicaid.
- Categorization of outcomes by foster care status and Medicaid eligibility.
Main Results:
- Children in foster care were 3-10 times more likely to have mental health diagnoses.
- They had 6.5 times more mental health claims and 7.5 times higher hospitalization rates for mental health conditions.
- Mental health expenditures were 11.5 times greater ($2082 vs $181) than for children in the Aid to Families With Dependent Children (AFDC) program.
Conclusions:
- Children in foster care have substantially higher rates of mental health conditions and service use than AFDC children.
- Service utilization and expenditures for foster care children mirror those of children with disabilities.
- Reimbursement rates and care management strategies for children in foster care require reevaluation.
Objective:
To determine the percentage of children with mental health diagnoses and utilization and expenditures of mental health services among children in foster care compared with other children receiving Medicaid, including those with disabilities.
Design:
Analysis of Medicaid claim and eligibility records in southwestern Pennsylvania for fiscal year 1995.
Population:
A total of 39,500 children between ages 5 and 17 years continuously eligible for Medicaid in southwestern Pennsylvania were included in the analysis.
Main Outcome Measures:
Percentage of children with mental health diagnoses and mental and general health care utilization and expenditures classified by participation in foster care and Medicaid eligibility.
Results:
Children in foster care were 3 to 10 times more likely to receive a mental health diagnosis, had 6.5 times more mental health claims, were 7.5 times more likely to be hospitalized for a mental health condition, and had mental health expenditures that were 11.5 times greater ($2082 vs $181) than children in the Aid to Families With Dependent Children (AFDC) program. Overall, utilization rates, expenditures, and prevalence of psychiatric conditions for children in foster care were comparable with those of children with disabilities.
Conclusions:
Children in foster care are significantly more likely to suffer from mental health conditions and use more mental health and general health services than AFDC children. Service use and expenditures are comparable with those of disabled children, suggesting that reimbursement rates and care management for children in foster care need to be reexamined.