Racial/Ethnic disparities in Medicaid funded psychotropic medication expenditure among maltreated children

OBJECTIVE To explore racial/ethnic disparities in Medicaid-funded psychotropic medication expenditures among children investigated for suspected child abuse and neglect. BACKGROUND Despite possessing entitlements to Medicaid, and health navigators in the form of assigned child welfare workers, children within welfare systems display racial/ethnic differences in mental health service use, including psychotropic drugs. METHODS We obtained data from four waves of the National Survey of Child and Adolescent Well-Being (NSCAW). The data were linked using social security numbers (SSNs) and residence data to Medicaid Analytic Extract (MAX) for years 2000 through 2003 covering fourteen states. We estimated two-part expenditures models to regress Medicaid psychotropic drug expenditures on NSCAW predictors, adjusted all expenditures to 2010 dollars, and developed predictive margins for variables of interest. The outcome of interest was Medicaid expenditures based on Redbook classification of drugs. RESULTS African American children have 45% lower odds of incurring Medicaid expenditures on psychotropic drugs compared to white children (p<0.01), controlling for mental health need, maltreatment histories, and other demographic characteristics. Older children and those in the clinical range of Child Behavior Checklist (Odds Ratio:3.58) have higher odds of psychotropic drugs expenditures (p<0.001). Conditional on any psychotropic drug expenditure, African American children on Medicaid incurred expenditures on psychotropic drugs that were $967 less than white children. CONCLUSION Such disparities in medication expenditures observed in spite of having access to Medicaid suggests that expansions of insurance coverage alone – as proposed in the Affordable Care Act – do not translate into equalities in service use.