494 - Caregiver perspectives on changes in pediatric behavioral healthcare since implementation of Medicaid ACOs in Massachusetts

Publication Number: 4485.494

Erin DeCou, UMass Amherst, Amherst, MA, United States; Berry Williams, Berry Williams (Project Coordinator UMass Amherst School of Public Health), Colrain, MA, United States; Charlotte F. Gilson, University of Massachusetts Medical School, Amherst, MA, United States; Kimberley Geissler, UMass Chan-Baystate, Springfield, MA, United States; Sarah Goff, University of Massachusetts, AMHERST, MA, United States

Background: The current pediatric behavioral health (BH) crisis disproportionately impacts Medicaid-insured populations. Massachusetts first implemented Medicaid Accountable Care Organizations (ACOs) in March 2018; new contracts in 2023 included pediatric BH quality measures and BH specific requirements in the sub-capitation scheme.

Objective: We aimed to understand caregivers’ experience of BH care for their Medicaid-insured child and their perceptions of changes in care following ACO implementation.

Design/Methods: Virtual, semi-structured interviews were conducted with caregivers of Medicaid-insured children with at least one BH condition between October 2024 and September 2025. Purposive sampling aimed to achieve variation in participant characteristics (e.g., race/ethnicity), geographic location, and ACO their child's pediatric practice contracted with. Interviews were conducted in English and Spanish via Zoom, audio-recorded, and transcribed verbatim. Transcripts were analyzed inductively and deductively using Charmaz’s constructivist grounded theory approach.

Results: Of the 30 participants, 45% identified as White, 35% as Hispanic or Latino, 7% as Asian, 7% as Black or African American, and 7% preferred not to answer. Participants were caregivers to children who received primary care through a Medicaid ACO at private practices (43%), community health centers (23%), practices owned by a national company (23%), and practices owned by a hospital (10%). Nine (53%) of the original 17 ACOs in Massachusetts were represented, including participants from 21 unique practices from all regions of the state. Major themes include: 1) most caregivers experienced few changes in their child’s BH care since 2018; 2) mixed perspectives of the role of medical and BH providers in BH care; 3) complexity of BH care system remains a barrier to timeliness of care and coordination despite ACO changes; 4) some caregivers described external BH organizations providing helpful care coordination via family partners; and 5) suboptimal processes for transitions of care remain a challenge.

Conclusion(s): Medicaid ACOs in Massachusetts aimed to transform delivery, including a focus on BH care in the 2023 contracts through enhancements of primary care. However, caregivers reported few changes to their experience of care for their child with a BH condition. An increased focus on pediatric BH care, via relevant metrics, resources for family navigation, and increasing accessibility to BH providers is needed.