IMPACT OF MEDICAID MANAGED CARE ON CHILD AND ADOLESCENT EMERGENCY MENTAL-HEALTH SCREENING IN MASSACHUSETTS

Objective: The study evaluated the impact of Medicaid managed care on decision making during emergency mental health screening and the outco mes of such screening for children and adolescents. Methods: Data on c lient attributes and on system characteristics (payer, referral source , and disposition) were available for 297 Medicaid and non-Medicaid ep isodes of emergency mental health screening that occurred one year bef ore the implementation of a statewide managed Medicaid program in Mass achusetts and 393 episodes that occurred one year after implementation . Outcomes included changes in the volume of service provided and in t he pattern of dispositions, particularly inpatient admissions. Results : Although the total volume of child and adolescent emergency screenin g episodes significantly increased after implementation of Medicaid ma naged care, inpatient admissions decreased significantly. Among episod es not covered by Medicaid, no significant changes were noted after im plementation on any variables. In the Medicaid group, significant diff erences were found in client attributes and system characteristics. Af ter implementation the volume of emergency screening episodes for Medi caid clients increased significantly and inpatient admissions decrease d significantly. The pattern of dispositions changed significantly; wi th increased use of newly available crisis stabilization services. Con clusions: Although implementation of Medicaid managed care achieved th e short-term goal of a decrease in hospitalizations, and probably conc omitant savings, issues of quality of care for children and adolescent s, and savings over the longer term, remain to be addressed.