Mental Health Services for Publicly-Insured Children in San Mateo County, California

The San Mateo Children's Health Initiative (CHI) has a goal of assuring that all children in the county have health insurance. As part of this effort, the Healthy Kids insurance program serves children up to 400 percent of the federal poverty level who are not entitled to private or other public insurance. The San Mateo CHI program evaluation examines the ongoing implementation of the Healthy Kids program and addresses specific research questions about children's public health insurance program services. This study, conducted as part of that evaluation, examines whether Healthy Kids enrollees obtain needed mental health services and explores barriers that may restrict access to these services. Data sources include information from site visit interviews conducted with key stakeholders, and claims/encounter data for children enrolled in the Health Plan of San Mateo for all three public health insurance programs (Healthy Kids, SCHIP/Healthy Families, and Medi-Cal). In both Healthy Kids and Healthy Families, enrollees with mental health diagnoses had higher average costs—both for mental health care and other care--than other enrollees. The prevalence of mental health problems (as reported by parents) is higher for Healthy Kids enrollees than the proportion of children using mental health services. Key stakeholders indicated that there are barriers to mental health care access for children served by Healthy Kids, Healthy Families, and Medi-Cal, such as lack of information, or undocumented parents' belief that participation in the county mental health system could lead to identification of their legal status.