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18 Medicaid Analytic eXtract Study
Pages 315-348

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From page 315...
... The MAX data provide a set of research files constructed from mandated periodical data submissions by the state Medicaid programs, compiled and processed by the Centers for Medicare & Medicaid Services (CMS)
From page 316...
... The prescription drug records were linked to the First Data Bank National Drug Data File (NDDF) , which provides the means to look up drug details using the national drug codes provided in the MAX data.
From page 317...
... Oppositional defiant disorder (ODD)
From page 318...
... Tables 18-3a and 18-3b summarize the 10-year trends in the estimated prevalence of mental disorders, speech/language and hearing disorders, asthma, and cerebral palsy diagnoses among all Medicaid enrollees and SSI Medicaid enrollees, respectively. A prevalence estimate for each diagnosis was generated by dividing the number of diagnoses by the number of all Medicaid enrollees within each year.
From page 319...
... 6.9% 6.5% 6.4% 6.4% 6.3% 6.4% 6.6% 6.4% 6.2% 5.8% Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% N (total # of all medicaid 5,232,083 5,749,809 6,144,784 6,356,411 6,658,353 6,630,423 6,593,490 6,899,748 7,545,081 8,208,507 enrollees) NOTE: Inclusion criteria: youth ages 3–17 with 11+ months of Medicaid eligibility and no dual eligibility in the year, in the last month of observation for the enrollee.
From page 320...
... As can be seen in Table 18-3b, among SSI Medicaid enrollees the percentage of children with a diagnosis of any one of the mental disorders
From page 321...
... , corresponding to an increase from 17,622 children in 2001 to 38,034 children in 2010. The percentage of SSI Medicaid enrollees with a diagnosis of cerebral palsy decreased by 8 percent (from 6.2 to 5.7 percent)
From page 322...
... As shown in the left-hand sections of Table 18-4 and detailed above, among all Medicaid enrollees, there is a steady increase over time in the proportion of children who are diagnosed with a mental disorder -- rising from 8.8 percent in 2004 to 11.1 percent in 2010, an increase of 26.1 percent over this interval. SSI Medicaid enrollees all have some qualifying disability by definition.
From page 323...
... , there is a growing trend of diagnoses of mental disorders. The rise in the prevalence of mental disorders observed among the SSI recipients is exceeded by the increasing prevalence among the entire Medicaid population, thus reflecting a larger secular trend.
From page 324...
... Additionally, the trend direction for mental disorder prevalence observed in the SSI program for children is consistent with overall trends among all Medicaid enrollees as well as among the subset of SSI Medicaid enrollees. However, while these global mental disorder trend comparisons are useful, comparisons of disorder specific trends may show different patterns.
From page 325...
... Third, mental disorder diagnoses increased at roughly similar rates among all eligibility categories and at rates that paralleled increases in
From page 326...
... First, a very low percentage of all children living in poverty receive SSI for mental disorders, even though a substantial minority of all Medicaid-enrolled children have mental disorder diagnoses. While the SSI eligibility requirement for a severe medically determinable impairment likely accounts for much of this difference, the marked discrepancy raises questions about the number of children in poverty with mental disorders who may be eligible for SSI but who do not receive benefits.
From page 327...
... Third, Table 18-4 shows a notable discrepancy between the number of SSI recipients with mental disorders and the number of SSI Medicaid enrollees with a mental disorder diagnosis. In 2010 there were 615,772 child recipients for mental disorders, while there were only 184,856 children who were enrolled in Medicaid and on SSI with a mental disorder diagnosis.
From page 328...
... NOTES: Mental health disorder: ADHD, conduct disorders, emotional disturbances, oppositional defiant disorder, depression, bipolar disorders, anxiety disorders, intellectual disorders, learning disorders, autism spectrum disorders. Inclusion criteria: youth age 3–17 with 11+ months of Medicaid eligibility and no dual eligibility in the year.
From page 329...
... TABLE 18-4  Change in Prevalence Estimates of Mental Disorders from 2004 to 2010 Among Children Enrolled in Medicaid and on SSI All Medicaid Enrollees SSI Medicaid Enrollees SSI Medicaid Enrollees Percent of Children from Number of Number of Households Percent All Medicaid Percent SSI/Disability Under 200% Number of SSI Diagnosed Enrollees Diagnosed Enrollees FPL with Recipients with with Any of Diagnosed with with Any Diagnosed with Any of the 10 Any of the 10 the 10 Mental Any Mental Mental Any Mental Major Mental Major Mental Disorders Disorder Disorder Disorder Disorders Disorders 2004  8.80% 561,252 32.20% 131,420 1.88% 540,051 2010 11.10% 907,731 38.60% 184,856 1.91% 615,772 Percentage increase 26.1% 19.8% 1.6% in the % of children with a mental disorder diagnosis NOTE: FPL = federal poverty level.
From page 330...
... stricter SSI adjudication processes for mental disorder impairment during this 7-year window. Given that the number of impoverished and Medicaid-eligible children has increased over the period of interest, and given that the prevalence of mental disorder diagnoses within the child Medicaid population increased at a rate commensurate with SSI recipients with mental disorders over the same period, it is likely that there is a substantial and growing population of children who are eligible to receive SSI benefits for mental disorders but who are not recipients.
From page 331...
... Tables 18-5a and 18-5b summarize the 10-year trends in the proportion of children with a comorbid mental disorder, speech and language disorder, hearing disorder, cerebral palsy and asthma among children with ADHD, among all Medicaid and SSI enrollees, respectively. In both 2001 and 2010, the most common comorbid mental disorders among all Medicaid enrollees who received paid treatment for ADHD were emotional disturbances (2001, 11.6 percent; 2010, 13.4 percent)
From page 332...
... . MENTAL DISORDERS BY RACE AND ETHNICITY The SSA does not keep or provide information on the race and the ethnicity of SSI recipients.
From page 333...
... . Some of this represents differential access to care by race and ethnicity (especially, for example, in diagnostic and treatment services for autism spectrum disorder)
From page 334...
... TREATMENT For certain mental disorders in children, appropriate treatment, including medication and psychological services, can significantly reduce impairment and improve outcomes. Treatment among the SSI disability population may have an effect on the rates of disability; as such, the SSA directed the committee to identify the types of care documented or reported to be received by children in the SSI population.
From page 335...
... . As a result, the types of medication and psychotherapy services that are paid on behalf of children enrolled in Medicaid with mental disorders can be tracked over time.
From page 336...
... SOURCE: MAX data for 20 states: AK, AL, AR, CA, FL, ID, IL, IN, LA, MI, MS, MT, NC, ND, NH, NM, SD, VA, VT, WY. Background Information on Treatment of Children with Mental Disorders on SSI and in Medicaid Few studies describe the treatment of children with mental disorders who also receive SSI benefits.
From page 337...
... Among all Medicaid-enrolled children diagnosed with ADHD, most received some Medicaid-paid treatment for their condition, ranging from 87 percent in 2001 to 92 percent in 2010. These proportions were similar to those among children who were SSI Medicaid enrollees, which increased from 85 percent in 2001 to 92 percent in 2010.
From page 338...
... In addition, the direction of the selection bias may be mixed because SSI Medicaid enrollees may have greater clinical severity that could drive greater service utilization because functional impairment is part of SSI benefit eligibility criteria. Treatment trends among SSI Medicaid enrollees were similar to those among all Medicaid enrollees.
From page 339...
... Among all Medicaid enrollees, the percentages of children receiving any treatment for depression, anxiety disorders, and ASD were 78.2, 73.8, and 71.2 percent, respectively. Among SSI Medicaid enrollees, the percentage of children with these disorders who received any treatment was 89.7, 84.7, and 69.2 percent.
From page 340...
... 340 TABLE 18-7  MAX Diagnoses by Race/Ethnicity, SSI Medicaid Enrollees, 2010 Black/ Am. Indian/ Hispanic/ More Than 1/ Diagnosis White African American Alaskan Native Asian Latino Unknown ADHD 23.3% 18.8% 18.4% 4.5% 10.3% 15.7% Conduct disorder 5.2% 5.1% 4.3% 2.1% 3.7% 4.1% Emotional disturbances 6.9% 6.6% 7.6% 1.0% 3.2% 4.1% Oppositional defiant disorder 5.6% 5.8% 5.7% 0.7% 2.2% 3.3% Depression 8.0% 5.5% 8.1% 1.9% 5.2% 3.9% Bipolar disorders 5.6% 2.2% 3.4% 0.7% 1.9% 1.9% Anxiety disorders 3.5% 1.3% 2.8% 1.0% 2.1% 1.7% Autism spectrum disorders 12.5% 3.7% 5.1% 11.0% 6.0% 5.8% Intellectual disorders 10.6% 3.8% 3.5% 25.9% 11.6% 3.9% Learning disorders 8.5% 5.5% 10.4% 5.3% 5.5% 7.3% Speech and language disorders 14.6% 9.0% 17.1% 10.9% 8.4% 14.0% Hearing disorders 11.4% 4.8% 10.6% 7.4% 10.1% 9.7% Cerebral palsy 8.6% 3.3% 5.1% 12.8% 9.1% 4.9% Asthma 6.3% 9.2% 8.5% 4.2% 7.4% 8.1% N 104,116 152,011 5,320 3,635 49,189 161,876
From page 341...
... TABLE 18-8a  ADHD Treatment Among All Medicaid Enrollees with a Diagnosis of ADHD, 2001–2010 Treatment Status 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Not treated 13.1% 12.2% 10.3% 8.5% 9.9% 10.0% 9.8% 9.3% 8.8% 8.0% Treated with 65.2% 66.8% 60.9% 52.6% 53.2% 52.5% 51.7% 51.8% 52.4% 53.2% medication only Treated with 3.2% 2.9% 4.6% 6.1% 6.2% 7.0% 7.2% 7.2% 7.0% 6.7% psychotherapy only Treated with both 18.5% 18.1% 24.2% 32.8% 30.8% 30.6% 31.4% 31.7% 31.8% 32.1% medication and psychotherapy N (# of children 157,867 181,400 217,970 248,157 280,223 286,997 306,834 349,037 405,795 448,796 among all Medicaid enrollees with an ADHD diagnosis)
From page 342...
... 342 TABLE 18-8b  ADHD Treatment Among SSI Medicaid Enrollees with a Diagnosis of ADHD, 2001–2010 Treatment Status 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Not treated 15.3% 14.6% 12.6% 11.0% 11.5% 10.2% 9.5% 9.3% 8.6% 7.6% Treated with 67.6% 68.4% 60.2% 49.6% 50.7% 50.5% 48.6% 48.0% 50.1% 50.2% medication only Treated with 2.2% 1.9% 3.6% 5.0% 5.2% 6.1% 6.6% 6.9% 6.0% 8.2% psychotherapy only Treated with both 14.9% 15.1% 23.6% 34.4% 32.6% 33.1% 35.3% 35.8% 35.3% 36.4% medication and psychotherapy N (# of children 38,466 42,603 48,485 53,357 59,756 60,492 62,787 69,149 81,051 84,519 among SSI Medicaid enrollees with an ADHD diagnosis)
From page 343...
... The reasons for the gap between indicated and delivered care fall outside the scope of this study. Limitations The Medicaid Study treatment findings have several limitations.
From page 344...
... The receipt of behavioral or educational interventions also may be under-reported because children with mental health conditions may receive services through special education programs or state-funded programs for persons with disabilities. Services that are not paid for by Medicaid could account for the low rates of treatment observed among children with intellectual and learning disorders.
From page 345...
... FINDINGS • The percentage of all Medicaid enrollees with a mental disorder diagnosis increased from 7.9 percent in 2001 to 11.1 percent in 2010, a growth rate similar to the increase observed for asthma diagnoses. The percentage of SSI Medicaid enrollees with a mental disorder diagnosis increased from 29.2 percent in 2001 to 38.6 percent in 2010.
From page 346...
... • The number of SSI Medicaid enrollees with ADHD with no re corded paid claims for treatment declined by almost 50 percent during the period, consistent with the other indicators of increased frequency of treatment. • Combination therapy for mental disorders was used with increas ing frequency from 2001 to 2010, but was documented in only about a quarter of the total mental disorder diagnoses by 2010.
From page 347...
... 2005. Effect of Medicaid eligibility category on racial disparities in the use of psychotropic medications among youths.


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