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Mental Disorders and Disabilities Among Low-Income Children (2015)

Chapter: Part IV: Medicaid Analytic eXtract Study

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Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Part IV

Medicaid Analytic eXtract Study

Part IV of the report summarizes the results and data interpretation of a 10-year multistate analysis using Medicaid service encounter and pharmacy claims data (hereafter referred to as the Medicaid Analytic eXtract [MAX] data and the “Medicaid study”). This study was commissioned by the committee and performed by researchers at the Rutgers University Institute for Health, Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, and the Center for Education and Research on Mental Health Therapeutics.1

The Medicaid study was commissioned by the committee in response to two elements of the task order. The first was the requirement to compare trends in the number of children with mental disorders in the Supplemental Security Income (SSI) program with trends in the prevalence of mental disorders observed among children in the general U.S. population. The second was the requirement to describe the kinds of treatments reported or documented to be received by children with mental disorders in the SSI population.

After extensive deliberation, the committee decided to commission an analysis of Medicaid data for the following reasons. First, the committee came to the conclusion that another comparison population of children with mental disorders in low-income families would add value to its analysis of trends based upon SSI data. Children who are SSI recipients and those enrolled in Medicaid are from low-income households; the comparison of trends in mental disorder diagnoses between these groups holds

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1 Scott Bilder, Cassandra Simmel, and Stephen Crystal (director).

Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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socioeconomic status relatively constant. This approach addresses a key limitation of comparing prevalence estimates for children receiving SSI with those for children in the general population. In addition, studying trends in the mental health diagnoses in the Medicaid population, stratified by basis of eligibility (i.e., SSI, foster care, or other, including low income) provides an additional data source with which to validate trends in the frequency of mental disorder diagnoses observed in the SSI disability program for children. Trends in the frequency of mental disorder diagnoses within the subpopulation of children on SSI and enrolled in Medicaid would be expected to align with trends observed in the SSI benefit population.

Second, the information currently available in either the Social Security Administration (SSA) administrative data or the published literature on the treatment of children in the SSI population for mental disorders was not adequate to fully complete the task order. The Medicaid data are the best available and the most efficient source of continuously collected data that simultaneously include information on a child’s SSI status, mental disorder diagnoses, and health services utilization. Further discussion about the relative strengths and weaknesses of the MAX data can be found in Chapter 2.

Finally, the Medicaid data provide additional information on the characteristics of children with disabilities that are not available from the SSI administrative data. As previously discussed in Chapter 2, the SSA does not have reliable information on the secondary impairments of SSI recipients, and does not collect any information on the race and ethnicity of SSI applicants or recipients. The Medicaid data can provide information on Medicaid enrollees with multiple diagnoses, as well as their race and ethnicity. Since this information is not available from the SSI data, the Medicaid data may also provide the best available data about mental disorder comorbidity among SSI enrollees, and the distribution of mental disorder diagnoses among different racial or ethnic categories.

In Part IV, comparisons will be made among three different populations from two different data sources:

MEDICAID DATA

  • “All Medicaid enrollees” This population includes all children (ages 3–17 years) who met the Medicaid Study criteria. This includes children who are enrolled in Medicaid on the basis of SSI, foster care, and for other reasons, including “Low-Income Families,” “Mandatory Poverty Level,” and “Medically Needy Children Under 18” (CMS, n.d.). For the purposes of this report, this population is here after referred to as “all Medicaid enrollees.”
Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
  • “SSI Medicaid enrollees” This population includes children who are eligible to be enrolled in Medicaid because they receive SSI disability benefits. This is a specific subset of all Medicaid enrollees that includes only the SSI-eligible children and excludes children eligible for Medicaid because of foster care status or other reasons. We hereafter refer to this group as “SSI Medicaid enrollees.”

SSA ADMINISTRATIVE DATA

  • “SSI recipients” This population includes children who receive SSI disability benefits. It should be noted that practically all children who receive SSI are eligible for Medicaid, but only an estimated 90 percent of SSI recipients are enrolled in Medicaid (Ireys et al., 2004).

This report on the Medicaid study is divided into five sections. Section 1 describes the design and methods of the Medicaid study. Section 2 summarizes the 10-year trends observed for the prevalence of all common childhood mental disorders using cerebral palsy and asthma as comparison groups. (Note that trends in the prevalence of specific diagnoses of attention deficit hyperactivity disorder [ADHD], oppositional defiant disorder and conduct disorder, autism spectrum disorder, intellectual disability, learning disability, and mood disorders from the Medicaid study are discussed in Part III of the report with other information on those specific disorders.) Section 3 summarizes 10-year trends observed for the prevalence of secondary comorbid mental disorders among children with a primary diagnosis of ADHD. Section 4 summarizes the prevalence of mental disorders by racial and ethnic category, for 2010. Section 5 summarizes the 10-year trends in treatment by modality (i.e., none, medication, psychotherapy, combined) for ADHD as well as variations in treatment modalities by specific mental disorders for 2010. Details about the methods are in Appendix F, and the complete results are in Appendix G.

REFERENCES

CMS (Centers for Medicare & Medicaid Services). n.d. List of Medicaid eligibility groups. www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Downloads/List-of-Eligibility-Groups.pdf (accessed July 17, 2015).

Ireys, H., D. Kasprzyk, A. Takyi, and J. Gillcrist. 2004. Estimating the size and characteristics of the SSI child population: A comparison between the NSCF and three national surveys. Mathematics Policy Research Paper No. 8671-980. www.ssa.gov/disabilityresearch/documents/nscf/finalcomparison/nscf-comparison-final.pdf (accessed July 17, 2015).

Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 312
Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 313
Suggested Citation:"Part IV: Medicaid Analytic eXtract Study." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

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