Medicaid Expenditures On Psychotropic Drugs for a National Sample of Children in Child Welfare
Methods: We linked children interviewed in the National Survey of Child and Adolescent Well-Being (NSCAW) to their Medicaid claims files obtained from 36 states. Medicaid Analytic Extract data for the years 2000-2003, during which NSCAW was fielded, was procured. We then used social security numbers to link NSCAW children deterministically to their claims (where available), and used probabilistic approaches to link other children with caregiver consent for linkage for a total of 2901 child-observations. We aggregated all claims per child by drug class using the industry-standard Red Book, and adjusted all expenditures to 2010 dollars. We identified child characteristics that placed children at higher risk of expenditures, and estimated econometric 2-part models to quantify expenditures associated with these characteristics.
Results: Children surveyed in NSCAW displayed an overall mean of $1593 in psychotropic medication expenditures. Stimulants ($602) and antidepressants ($549) were the primary cost drivers. Male participants had $688 increased mean expenditures compared to females (p<0.01); African-American respondents incurred a mean of $594 lower expenditures compared to whites (p<0.05) despite having no differences in need. Age was strongly predictive of expenditures, with youth aged 14 years or older displaying a mean of $1561 in medication expenditures compared to those aged between 3 and 5 years (p<0.001). The best instrument for assessing risk of expenditures was the Child Behavior Checklist (CBCL). Children scoring in the clinical range of the CBCL had higher expenditures ($679) than those scoring in the normal range (p<0.001). There were no significant rural-urban differences in spending. Maltreatment history and placement status were generally not significantly associated with spending on psychotropic drugs; only children with histories of physical abuse displayed increased expenditures of $152 on average compared to those without physical abuse.
Conclusion and Implications: Each child coming into contact with child welfare agencies is likely to incur nearly $1600 in mean annual psychotropic medication expenditures throughout his or her enrollment in Medicaid. Assuming representativeness of our linked sample, and 6.2 million children presenting to child protection agencies in FFY2011, Medicaid agencies may be spending nearly $10 billion annually in the purchase of psychotropic medications for children in the child welfare system. This enormous expenditure suggests the need to expand use of instruments such as the Child Behavior Checklist to identify high-cost children, and then deliver intensive psychiatric and psychosocial services to them in order to contain costs of care. Such targeted intervention strategies may enhance the well-being of children in child welfare environments.