Medicaid Accountable Care Organization Implementation and Behavioral Health Care for Children

Area of Science:

• Health Services Research
• Pediatric Behavioral Health
• Public Health Policy

Background:

• Medicaid insures a significant portion of US children, with increasing adoption of Accountable Care Organizations (ACOs) for service delivery reform.
• Limited understanding exists regarding the impact of Medicaid ACOs on the behavioral health outcomes of children.

Purpose of the Study:

• To assess the association between Medicaid ACO implementation and behavioral health care access, unmet needs, and care experience in Medicaid-insured children.
• To analyze changes in care access and quality for children with behavioral health conditions before and after Medicaid ACO implementation.

Main Methods:

• A repeated cross-sectional study utilizing data from the National Survey of Children's Health (2016-2023).
• Employed a difference-in-differences design comparing states with and without Medicaid ACO implementation (2017-2022).
• Included Medicaid-insured children aged 3-17 with reported behavioral health conditions.

Main Results:

• Medicaid ACO implementation was associated with a 4.76 percentage point increase in unmet mental health needs.
• No significant associations were found with having a personal physician, receiving mental health treatment, care coordination, or family-centered care.

Conclusions:

• Medicaid ACO implementation did not yield broad improvements in behavioral health care for children.
• Findings indicate a need for pediatric-specific strategies and workforce investments within ACOs to address children's behavioral health needs.