Date: September 1st, 2007
Data on mental health service use is critical to understanding the system of mental health care for children. In addition, such data can provide a baseline against which policymakers can assess access to mental health services in light of prevalence estimates or future policy interventions designed to increase access to mental health services. This analysis assesses private insurance claims data, Medicaid data, and data on care provided to those without insurance from hospital discharge data and from the community mental health system. This report is one of a series of reports commissioned to inform policy-makers about the status of mental health in New Hampshire. This analysis is designed to answer basic questions about the mental health service system by analyzing the services that are being provided to those with mental illnesses.
The public Medicaid system provides a significant amount of mental health services to children in New Hampshire. One-quarter of all children enrolled in Medicaid access services for a mental illness at a cost of $81 million – more than half of the total medical expenditures for children. Surprisingly, children enrolled in Medicaid via Temporary Aid to Needy Families (TANF) comprise the majority of the total mental health expenditures. But, not surprisingly, the average costs for mental health care to children with permanent disabilities or to children in the foster care system are higher then other Medicaid eligible children.
While the traditional community mental health system represents a significant share of the total services provided to children, the data confirm that other organizations charged with the health, education, and general welfare of children in New Hampshire also play a significant role. Three relatively distinct systems define the public mental health provider system in New Hampshire: the community mental health centers, the public school system, and therapeutic foster care providers. The costs for the services they provide constitute 74% - $60 million - of the total expenditures for mental health services.
At least measured by non-pharmacy total expenditures, the private insurance system plays a much smaller role in the provision of mental health services for children. In total, in 2005, there were approximately $15 million in payments for mental health services provided to children. Moreover, whereas the children in the public system are largely receiving services through the public systems, including the schools, the expenditures for the private system were predominately for office-based individual psychotherapy rather than comprehensive rehabilitative services.
The analysis of self-pay hospital discharge suggests that the hospital system provides a relatively small amount of care to children lacking insurance or those that lack coverage for specific mental health services. Charges for mental health services amounting to almost $19 million were provided to self-pay individuals of all ages in 2004. Of this amount, only $666,000 was for children. This is not surprising given the fact that the rate of children lacking insurance is much lower than it is for adults.
The lack of data regarding service use and diagnostic information – particularly for the services provided through the schools – is of some concern. While the data provides much information on the children’s mental health service system, there is at least one aspect of the mental health delivery system that remains opaque. For almost half the total Medicaid expenditures, the data was missing diagnosis information, making it difficult to explore the reasons for these children to seek care. Moreover, it is clear that the program is funding providers to deliver mental health services to vulnerable children, but the administrative claims data does little to shed light on what is actually being provided. Further analysis – likely involving surveys of school districts, the mental health clinics and the various providers of therapeutic services to foster children – would be required to better understand the types of services that are being provided.