When is neuropsychological testing medically necessary for children on medicaid in New Mexico?
Noah K Kaufman1, Carola Mullins2, Andrew S Davis3
1a Center for Neuropsychological Studies, Psychiatry, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine , Texas.
Insights
Medicaid, a healthcare program for children, is vital in states like New Mexico. This study examines neuropsychological health needs and the denial of testing, highlighting long-term costs of untreated conditions.
Area of Science:
- Neuropsychology
- Public Health
- Health Economics
Background:
- Children in low-income states like New Mexico disproportionately rely on Medicaid.
- These populations face higher rates of unintended pregnancies, domestic violence, substance use, crime, and lower educational attainment.
- There is a significant gap in research on the neuropsychological health of these vulnerable children.
Purpose of the Study:
- To address the question of neuropsychological medical necessity for children in New Mexico.
- To analyze community-based neuropsychological data from both Medicaid and non-Medicaid youth.
- To discuss the downstream fiscal implications of poor neuropsychological health.
Main Methods:
- Retroactive chart review of community-based neuropsychological data.
- Inclusion of both Medicaid and non-Medicaid youth from New Mexico.
- Analysis focused on identifying patterns and needs related to neuropsychological health.
Main Results:
- Non-neuropsychologists often deny necessary neuropsychological testing, citing lack of medical necessity.
- Data indicates a need for neuropsychological evaluation in this underserved population.
- Poor neuropsychological health is linked to significant future costs associated with mental illness and crime.
Conclusions:
- Neuropsychological testing is medically necessary for children in high-need populations.
- Denial of testing by managed care organizations has significant long-term fiscal consequences.
- Further research and policy changes are needed to ensure access to essential neuropsychological care for vulnerable children.
Abstract:
Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.
