Assessing Strengths and Well-Being in Primary Care for Adolescents With Mental Health and Substance Use Concerns.

As the COVID-19 pandemic highlighted gaps in meeting adolescent behavioral health needs, primary care providers (PCPs) were a locus for interventions to address adolescent mental health and substance use concerns. Strength-based approaches may support PCP promotion of positive behavioral health in adolescents, but competing priorities or other factors may inhibit their use. We analyzed health record review data from 31 primary care practices to assess utilization of strength-based approaches during the health supervision visit (HSV) for adolescents with and without behavioral health concerns.

Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs.

Objective: To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states.

Data Sources: Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008.

Study Design: We studied black, Latino, and white Medicaid beneficiaries with schizophrenia.

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs.

Background: U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually.

There is little experience and limited data to support policy making on integrated care for dual eligibles.

Coordinating care for the nine million elderly or disabled and low-income people who are dually eligible for Medicare and Medicaid is a pressing policy issue. To support the debate over this issue, we synthesized public data on how services are provided to dual eligibles receiving covered benefits in both programs. Our analysis confirmed that most dual-eligible beneficiaries receive benefits separately for each program through fee-for-service arrangements.

Medicaid expansion under health reform may increase service use and improve access for low-income adults with diabetes.

Medicaid's key role in financing diabetes care will grow when many low-income uninsured people with diabetes gain eligibility to the program in 2014 under the Affordable Care Act. Using a national data set to describe current health care use and spending among the nonelderly, low-income adult population, we found that adult Medicaid beneficiaries with diabetes had total annual per capita health expenditures more than three times higher ($14,229 versus $4,568) than those of adult beneficiaries without diabetes. At the same time, Medicaid facilitates financial protection and care access among beneficiaries with diabetes.

Behavioral health services in separate CHIP programs on the eve of parity.

The Children's Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits.

The impact of national health care reform on adults with severe mental disorders.

Objective: Little is known about the effect recent health care reform legislation will have on coverage of individuals with severe mental disorders. The authors examined current and predicted sources of insurance coverage and use of mental health services among adults with and without severe mental disorders and modeled postreform changes.

Method: The authors obtained sociodemographic, health status, mental health care use, and insurance coverage data from the 2004-2006 Medical Expenditure Panel Surveys to estimate changes that will occur after reform is fully implemented in 2019.

Health reform and the scope of benefits for mental health and substance use disorder services.

The Patient Protection and Affordable Care Act will expand insurance coverage to millions of Americans with mental disorders. One particularly important implementation issue is the scope of mental health and substance abuse services under expanded health insurance coverage. This article examines current public and commercial insurance coverage of the range of services used by individuals with mental illnesses and substance use disorders and assesses the implications of newly mandated standards for benefit packages offered by public and private plans.

Mental health policy development in the States: the piecemeal nature of transformational change.

Objective: Transformation--systemic, sweeping changes to promote recovery and consumerism--is a pervasive theme in discussions of U.S. mental health policy.

Managed behavioral health care carve-outs: past performance and future prospects.

As the managed behavioral health care market has matured, behavioral health carve-outs have solved many problems facing the delivery of behavioral health services; at the same time, they have exacerbated existing difficulties or created new problems. Carve-outs developed to address rising inpatient behavioral health costs and limited insurance coverage. They are based on the economic principles of economies of specialization, economies of scale, price negotiation, and selection.

State preparedness for bioterrorism and public health emergencies.

The nation's ability to prepare for and respond to an infectious disease or bioterrorist attack rests largely in states' public health systems. Early federal efforts to provide funding to help states and localities build their infrastructure have led to a great deal of activity in this area. Evaluations of progress in preparedness show both successes and shortcomings, and assessments of whether or not the nation is prepared vary depending on benchmarks used and perspectives on spending priorities.

Accomplishments and challenges in Medicaid mental health.

Although Medicaid was not designed as a mental health program, it is now a major source of financing for mental health services and care, especially for the chronically mentally ill. This paper examines the role Medicaid plays today for the low-income population with mental health needs and then reviews some of the current pressures and challenges in the program that could reshape this role.

Historical overview of children's health care coverage.

America's public health insurance programs reflect a deeply rooted commitment to caring for low-income families and children. This article chronicles the evolution of Medicaid and the State Children's Health Insurance Program (SCHIP), two public programs designed to provide free or low-cost health coverage to low-income children who do not have access to private health insurance. Such a historical overview is key to understanding where the programs come from and the challenges that policymakers must grapple with in order to effectively provide health coverage to children.

Health insurance for unemployed workers.

Objective: In this article, we seek to inform the debate over providing assistance to workers who lose their jobs during the recession by assessing the potential impact of an economic downturn on health insurance coverage and reviewing available approaches to secure coverage for unemployed workers and their families. We also summarize recent research and analysis to examine the likely challenges and benefits of these approaches.

Data Source: Data and analysis are primarily based on the Census Bureau's Current Population Survey, the Urban Institute's National Survey of America's Families, and Medicaid data from the Centers for Medicare and Medicaid Services.

Health Care for the Poor: Medicaid at 35.

Over its 35-year history, Medicaid has grown from a program to provide health insurance to the welfare population to one that provides health and long-term care (LTC) services to 40 million low-income families and elderly and disabled individuals. Despite its accomplishments in improving access to health care for low-income populations, Medicaid continues to face many challenges. The future of Medicaid as our Nation's health care safety net will be determined by Medicaid's ability to broaden health coverage for the low-income uninsured, secure access to quality care for its growing beneficiary population, and manage costs between the Federal and State governments.