Child Behavioral Health Service Use and Caregiver Strain: Comparison of Managed Care and Fee-For-Service Medicaid Systems

Abstract

This study compares behavioral health service utilization patterns and their determinants among Medicaid-enrolled children, ages 5-17 (N = 676) who were being served under managed care in Tennessee or a traditional fee-for-service system in Mississippi. Children in the fee-for-service program were significantly more likely than their counterparts in the managed care Medicaid program to receive behavioral health services (i.e., any service, support services, traditional outpatient services, day treatment, inpatient/residential care) and to receive more services overall. This finding held after controlling for the influence of other factors. Although child, family, and community variables were related to service use patterns, the relationships differed across systems. Caregiver strain was associated with several service use variables, but its influence was more pronounced in Tennessee. These findings support continued focus on the multi-level factors that shape behavioral health service use among children.