Access to Children's Mental Health Services under Medicaid and SCHIP

No. B-60 in Series, "New Federalism: National Survey of America's Families"

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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At least one-tenth of children suffer from a serious mental health problem that causes impairment (U.S. Public Health Service 2000). Because parents and providers are often reluctant to label a child with a specific diagnosis, the general term serious emotional disturbance (SED) is commonly used for severe problems. Poor children have more mental health problems than other children (Costello et al. 2003). Since more low-income children are now eligible for public health insurance through the Medicaid "poverty expansions" and the new State Children's Health Insurance Program (SCHIP), half of all children are potentially eligible for public health insurance coverage (Dubay, Haley, and Kenney 2002). Consequently, such programs play a critical role in ensuring access to child mental health services.

This brief fills some of the knowledge gaps about the unique roles of Medicaid—the dominant payer for mental health services for poor children—and SCHIP, a newer program whose role is still evolving. The brief first reviews coverage policy for mental health services for Medicaid and SCHIP. It then provides new information on the prevalence of mental health problems for Medicaid and SCHIP children, and their use of mental health services. Together, this information will help guide Medicaid and SCHIP policy regarding how best to serve children.

Methods

To learn in detail about Medicaid and SCHIP policies for children's mental health coverage, we conducted telephone interviews with state officials in the 13 Assessing the New Federalism (ANF) focal states, a group of states whose social policies are monitored regularly by the Urban Institute (Kondratas, Weil, and Goldstein 1998).¹ The ANF states include 53 percent of the children enrolled in Medicaid and 63 percent of those enrolled in SCHIP, for the most recent years data are available. Semistructured interviews were conducted from mid-August to mid-October 2003, using a standard protocol.

A new analysis of data from the 2002 round of the National Survey of America's Families (NSAF) provides recent information on the prevalence of emotional and behavioral problems (here called "mental health problems") and the use of mental health services among children nationwide, according to poverty level and insurance coverage. For children 6-17 years old, parents were asked how often their child felt worthless or inferior, had been nervous or tense, or acted too young for their age. Parents of children 12-17 years old were also asked how often their child had trouble sleeping, lied or cheated, or had trouble at school. Responses were combined into a scale from 1 (most severe problems) to 18 (no problems). Children with mental health problems are those with a score of 12 or lower. Parents were also asked whether their child "received mental health services, including mental health services from a doctor, mental health counselor, or therapist."²

Notes from this section

1. The ANF states are Alabama, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, Texas, Washington, and Wisconsin.

2. For more information on the NSAF or the child behavior checklist, see Ehrle and Moore (1999) or http://anf.urban.org.

Note: This report is available in its entirety in the Portable Document Format (PDF).

About the Series

This series presents findings from the 1997, 1999, and 2002 rounds of the National Survey of America's Families (NSAF). Information on more than 100,000 people was gathered in each round from more than 42,000 households with and without telephones that are representative of the nation as a whole and of 13 selected states (Alabama, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, Texas, Washington, and Wisconsin). As in all surveys, the data are subject to sampling variability and other sources of error. Additional information on the NSAF can be obtained at http://newfederalism.urban.org.

The NSAF is part of Assessing the New Federalism, a multiyear project to monitor and assess the devolution of social programs from the federal to the state and local levels. Olivia A. Golden is the project director. The project analyzes changes in income support, social services, and health programs. In collaboration with Child Trends, the project studies child and family well-being.

The Assessing the New Federalism project is currently supported by The Annie E. Casey Foundation, The Robert Wood Johnson Foundation, the W. K. Kellogg Foundation, The John D. and Catherine T. MacArthur Foundation, and The Ford Foundation.

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