Lagging coverage for mental health services among children and adolescents through home and community-based Medicaid waivers.
Jessica Keim-Malpass, Leeza Constantoulakis, Emily K Shaw and 1 others
PMID 36075862WHAT IT FOUND
Children and adolescents with serious emotional disturbance had Medicaid home and community-based waivers with under $7000 per person per year and no covered therapy or skilled nursing services, unlike autism or medical complexity waivers.
Clinicians should expect funding gaps.
Key findings
01Only 5% of the 142 waivers targeted serious emotional disturbance.
02Annual spending was under $7000 per person for serious emotional disturbance waivers, compared with nearly $37,000 for autism/intellectual/developmental disability waivers.
03None of the serious emotional disturbance waivers covered therapy services, skilled or private duty nursing, personal care, or treatment/dietary services.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The analysis looked only at 1915(c) Medicaid waivers, not other ways states may finance mental health services. It included 142 waivers from 5 states, so it may not represent every state or every child. It did not measure whether children actually received services or had improved health outcomes. States described services and eligibility differently, making comparisons difficult. The analysis could not include 1115 demonstration waivers because they are not standardized. Waivers do not report spending by program type within a waiver, limiting mental health component comparisons.
Declared interests
The authors declared no conflict of interest, and the article is classified as supported by non-U.S. government research.
The easy way to misread this
Do not read this as evidence that therapy or nursing services are clinically unnecessary for children with serious emotional disturbance. It reports Medicaid waiver coverage gaps, not patient need or treatment effectiveness.