22 - Association of Insurance Type with Receipt of Pediatric Behavioral Health Specialty Care

Publication Number: 3019.22

Kimberley Geissler, UMass Chan-Baystate, Springfield, MA, United States; Meng-Shiou Shieh, baystate health, Springfield, MA, United States; Jessica Pearlman, University of Massachusetts Amherst Institute for Social Science Research, Greenfield, MA, United States; Barry Sarvet, University of Massachusetts Medical School, Springfield, MA, United States; Sarah Goff, University of Massachusetts, AMHERST, MA, United States

Background: Rates of behavioral health (BH) conditions among children have risen rapidly. Many, particularly low-income children insured by Medicaid, face barriers to evidence-based treatment. Although the number of child and adolescent psychiatrists has increased, shortages of BH specialists persist, and many children who may benefit from specialty care do not receive it. At the same time, pediatric primary care clinicians are increasingly providing screening, diagnosis, and treatment, often supported by integrated BH teams. Despite these shifts in the delivery of pediatric BH care, little is known about patterns of specialist use and variation by insurance type or diagnosis.

Objective: To examine specialist use for pediatric BH conditions based on insurance type and diagnosis.

Design/Methods: Using Massachusetts All Payer Claims Data (2014-2021), we identify children aged 0-17 with a BH condition and an outpatient BH visit with a prescribing clinician. Receipt of any outpatient BH specialist care includes a visit with a child or general psychiatrist, NP/PA with a psychiatric specialty, community mental health center, child or general neurologist, or developmental behavioral pediatrician. Logistic regression compares receipt of BH specialist care by insurance type (Medicaid vs. private), accounting for age, sex, BH diagnosis, comorbidities, and ZIP characteristics. Additional models estimate differences in receipt of specialist care by insurance type for each diagnosis.

Results: There were 824,766 child-year observations with a qualifying visit, 54.1% with Medicaid. 21.7% had any outpatient BH specialist care (18.6%Medicaid, 25.4% private insurance, p< 0.001). After accounting for demographic, diagnosis, and ZIP characteristics, there was a 6.7 percentage point (pp) higher probability of any outpatient BH specialist care for privately insured versus Medicaid. This gap was present across different diagnoses, with a difference of 8.1 pp (23.5 Medicaid vs. 31.5 private) for those with ADHD, 17.0 pp (22.9 Medicaid vs. 39.9 private) for those with depression, and 12.3 pp (16.1 Medicaid vs. 28.2 private) for those with schizophrenia.

Conclusion(s): Although the optimal rate of BH specialist care for children with BH conditions is not established, observed disparities between Medicaid and privately insured children, including those with severe mental illness, underscore the importance of monitoring specialist use to ensure equitable access to high-quality care.