Youth with mood disorders in Medicaid: A comparison of trends in access to treatment between managed care and fee-for-service

The Problem: Mood disorders such as depression and mania are the third most common category of psychiatric disorders in youth. An estimated 6 percent of youth ages 9 to 17 experience a mood disorder annually. Many state Medicaid programs have introduced managed care approaches, which could have important effects on access for youth to outpatient mental health clinical treatment and psychotropic medications. Managed care often encourages the substitution of clinical care for psychotropic medications which have few clinical trials supporting their use in youth, especially young children.

Research Questions: Compared to fee-for-service care, does Medicaid managed care result in: 1). Increasing access to case management and pharmaceuticals; 2) Decreasing access to outpatient mental health services; and 3) Reducing disparities for rural youth and youth that are African American.

Study Design: Data are from Medicaid programs in Tennessee (under managed care since 1994) and Mississippi (fee-for-service). The study includes two components: 1) a quasi-experimental design with a pre-post clinical outpatient care data from Tennessee and Mississippi; and 2) a pre-post design for pharmaceutical use in Tennessee. The study focuses on mental health access trends over ten years (6 months premanaged care, 2 years transition, and 7.5 years post-managed care). The analysis will use survival analysis and logistic and ordinary least squares regression.

Implications: Results of this dissertation may help future state Medicaid agencies, clinicians, and parents of youth with mood disorders understand the impact of managed care during the rapid change in treatment patterns for mood disorders in the1990s.