Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states.

Background And Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line.

Therapists' perspectives on access to telemental health among Medicaid-enrolled youth.

Objective: The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when services are delivered via synchronous telehealth to Medicaid-enrolled youth.

Study Design: Between December 2020 and March 2021, we conducted in-depth interviews with 19 therapists from a large safety-net organization who served Medicaid-enrolled youth (< 18 years of age) to elucidate their perspectives on barriers to and facilitators of access to telemental health services among this population.

State-Level Variation in Medicaid Managed Care Enrollment and Specialty Care for Publicly Insured Children.

Importance: Medicaid and Children's Health Insurance Program cover almost 50% of children with special health care needs (CSHCN). CSHCN often require specialty services and have been increasingly enrolled in Medicaid managed care (MMC) plans, but there is a dearth of recent national studies on specialty care access among publicly insured children and particularly CSHCN.

Objective: To provide recent, nationwide evidence on the association of MMC penetration with specialty care access among publicly insured children, with a special focus on CSHCN.

Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries.

We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations.

Evaluating Medicaid Managed Care Network Adequacy Standards And Associations With Specialty Care Access For Children.

Medicaid managed care plans cover more than 80 percent of Medicaid-enrolled children, including many children with special health care needs (CSHCN). Federal rules require states to set network adequacy standards to improve specialty care access for Medicaid managed care enrollees. Using a quasi-experimental design and 2016-19 National Survey of Children's Health data, we examined the association between quantitative network adequacy standards and access to specialty care among 8,614 Medicaid-enrolled children, including 3,157 with special health care needs, in eighteen states.

Employee Engagement in Quality Improvement and Patient Sociodemographic Characteristics in Federally Qualified Health Centers.

Quality improvement (QI) work is critical, particularly in federally qualified health centers (FQHCs) that treat underserved populations. In a national sample of 45 FQHCs, we examined how patients' sociodemographic characteristics were associated with employee engagement in QI, via innovation contests that solicited ideas for improving care and offered opportunities to vote on ideas. We posited that patients' sociodemographic characteristics influence the complexity and intensity of clinical work and thus employees' capacity to engage in QI.

Mental Health Clinic Administrators' Perspectives on the Impact of Clinic-School Partnerships on Youth Mental Health Services Continuity and Quality.

Partnerships between mental health (MH) clinics and school systems in which providers deliver MH services on school grounds are growing. To date, however, there is little research examining MH clinic administrator perspectives on how this service delivery model affects continuity and quality of MH services among low-income youth. We conducted a state-wide (online and mail) survey of administrators at MH clinics ( = 60) to assess their perspectives on the advantages and challenges of school MH services for Medicaid-enrolled youth.

National Estimates of Mental Health Needs Among Adults With Self-Reported CKD in the United States.

Introduction: Among adults with chronic kidney disease (CKD), comorbid mental illness is associated with poorer health outcomes and can impede access to transplantation. We provide the first US nationally representative estimates of the prevalence of mental illness and mental health (MH) treatment receipt among adults with self-reported CKD.

Methods: Using 2015 to 2019 National Survey on Drug Use and Health (NSDUH) data, we conducted an observational study of 152,069 adults (age ≥22 years) reporting CKD ( 2544), with no reported chronic conditions ( 117,235), or reporting hypertension (HTN) or diabetes mellitus (DM) but not CKD (HTN/DM, 32,290).

Recent Trends in School-Based Mental Health Services Among Low-Income and Racial and Ethnic Minority Adolescents.

This survey study uses publicly available data from the National Survey on Drug Use and Health to evaluate school-based mental health (MH) service use among low-income and racial and ethnic minority adolescents.

Association Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth.

Objective: Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth.

Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors.

Background: Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy.

Methods: Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group.

Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis.

Background: Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment.

Racial and Ethnic Disparities in Kidney Replacement Therapies Among Adults With Kidney Failure: An Observational Study of Variation by Patient Age.

Rationale & Objective: Non-Hispanic Black and Hispanic patients present with kidney failure at younger ages than White patients. Younger patients are also more likely to receive transplants and home dialysis than in-center hemodialysis (ICHD), but it is unknown whether racial and ethnic disparities in treatment differ by age. We compared use of kidney replacement therapies between racial and ethnic groups among patients with incident kidney failure overall and by age.

Trends in Alcohol Use Disorder Treatment Utilization and Setting From 2008 to 2017.

Objective: Little is known about recent trends in treatment for alcohol use disorder. The authors used national data to examine treatment trends among individuals with alcohol use disorder.

Methods: A sample of nonelderly adults (ages 18-64 years, N=36,707) with alcohol use disorder was identified from the National Survey on Drug Use and Health.

Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network.

Objective: Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change.

Stakeholder perspectives on the advantages and challenges of expanded school mental health services for publically-insured youth.

Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services.

National estimates of mental health service use and unmet needs among adult cancer survivors.

Background: Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors.

Methods: Respondents aged 18 to 64 years were identified from the 2015-2018 National Survey of Drug Use and Health data.

Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey.

Background: Substance use can exacerbate cancer-related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors.

Methods: The authors used data from the National Survey of Drug Use and Health (2015-2018) to identify a nationally representative sample of AYAs aged 12 to 34 years.

The impact of urgent care centers on nonemergent emergency department visits.

Objective: To estimate the impact of urgent care centers on emergency department (ED) use.

Data Sources: Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states.

Study Design: We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed.

Medicaid Managed Care and Providers' Perceptions of Quality of Care for Children with Chronic Conditions in Georgia.

Medicaid managed care plans employ cost containment tools such as prior authorization and preferred drug lists to achieve cost savings. Little is known about these tools' effects on quality of care for beneficiaries with chronic conditions. We surveyed physicians and nurse practitioners based in federally qualified health centers (FQHCs) in Georgia to capture how they perceive these tools affect care and health outcomes for Medicaid-enrolled patients with chronic illnesses.

The Changing Landscape of Community Mental Health Care: Availability of Treatment Services in National Data, 2010-2017.

Objective: The authors sought to describe changes in availability of crisis and substance use treatment services in U.S. mental health facilities (including outpatient and inpatient facilities) from 2010 to 2017.