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Behavioral Health Treatment by Service Type and Race and Ethnicity for Children and Youth Involved with the Child Welfare System

Publication Date
Sarah Lieff, Chandra Couzens, Laura Radel, Mir M. Ali, Kristina West

Children and youth involved with the child welfare system frequently have behavioral health conditions and are high users of behavioral health services compared to children and youth in other Medicaid eligibility categories. To ensure the needs of these vulnerable children and youth are addressed, Federal law requires that states establish policies and practices to assure children in foster care receive appropriate health care, including mental health services. This brief, based on Medicaid administrative data for the period 2018-2020, describes national trends in receipt of key behavioral health service types for Medicaid beneficiaries in the child welfare population and other beneficiaries, characterizes racial/ethnic differences in service utilization for the child welfare population compared to their non-child welfare peers, and discusses implications for future research and policy planning related to ongoing disparities among youth of color.

Key findings include:

  • Child and adolescent Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries with child welfare involvement in 2019 (ages 3 through 17) were more likely to receive various behavioral health services than other children and youth in Medicaid and CHIP and experienced more service encounters per beneficiary, indicating a higher intensity of service receipt.
  • Just over half of those Medicaid/CHIP-enrolled children and youth involved in the child welfare system with behavioral health diagnoses received practitioner services and psychotherapy/counseling/other psychiatric services. Other common service types for these beneficiaries included screening/assessment/other diagnostic services (45.0 percent), community support (26.0 percent), and case management (23.5 percent).
  • White children used behavioral health services at the highest rates compared to children from all other racial/ethnic groups, while Asian children received services at the lowest rates.
  • Racial/ethnic differentials in behavioral health service receipt are substantially less pronounced among Medicaid and CHIP beneficiaries in the child welfare population compared to other child and adolescent Medicaid and CHIP beneficiaries.

This brief follows up on ASPE's 2023 publication, Behavioral Health Diagnoses and Treatment Services for Children Involved with the Child Welfare System.

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