No One's Priority: The Plight of Children with Serious Mental Disorders in Medicaid Systems. A Report on Six Focus Groups in Two States.

With a quarter of the country's children enrolled in Medicaid, the program has become an extremely important source of funding of all public health care for children and now provides half of all spending on public mental health systems. In 2002 the Bazelon Center undertook to examine whether Medicaid-eligible children were, in fact, receiving an expanded range of services in their communities. Working with local advocates, the Bazelon Center convened focus groups of parents with children in two states with relatively comprehensive Medicaid plans, New York and Oregon. This report summarizes findings from the 68 parents of 86 children and adolescents who took part in the six focus groups. While most Medicaid-eligible children with serious mental or emotional disorders continue to be served through traditional fee-for-services arrangements, some states have shifted all or part of their child mental health services to managed care programs. Researchers wanted to learn about differences, if any, between a fee-for-service state and a managed care state. Oregon has a managed care Medicaid system while in New York, Medicaid services for children with serious mental disorders are funded through fee-for-service. However, the similarity of the parents' accounts in the two states suggests that the differing structure of the programs has little effect on the ground. On paper, New York and Oregon describe a wide range of intensive community services for children through the psychiatric rehabilitation services category of Medicaid, but many parents in both states reported that their children seldom had access to more than basic medical and therapy services. An appendix contains the focus group methodology. (GCP)