Leveraging Medicaid to Support Children and Youth Living With Complex Behavioral Health Needs

Jocelyn Guyer, Senior Managing Director, Manatt Health | Gina Rogari, Manager, Manatt Health | Michaiah Parker, Senior Analyst, Manatt Health | Sheamekah Williams, President of Evolution Foundation | John O’Brien, Consultant

Editor’s Note: In a new report prepared for The Commonwealth Fund, Manatt Health and its co-authors provide an actionable framework and strategies for how state-level policymakers can use Medicaid and the Children’s Health Insurance Program (CHIP) to respond to the behavioral health crisis among children and youth living with complex needs.

The report was informed by the expertise and lived experience of members of a National Advisory Committee and a Youth Advisory Committee. Youth MOVE National was a key partner and facilitated the involvement of ten young people ages 18 to 29 in the Youth Advisory Committee.

Key strategies highlighted in the report are summarized below. To download a free copy of the full report, click here.  To register for our free webinar featuring a panel of innovators driving change sharing approaches for responding effectively to the behavioral crisis among young people, click here.

The COVID-19 pandemic exacerbated the already-growing mental health and substance use disorder (SUD) (behavioral health) crisis gripping children and youth in the United States. It has spurred federal, state and other actions to expand funding and treatment opportunities to improve the behavioral health and well-being of these young people. The crisis is impacting children, adolescents, young adults, and their families and caretakers across all social and demographic levels. Addressing it requires a concerted effort across multiple sectors, including health, education, justice and child welfare. Medicaid, the largest health insurer for children and adolescents and primary payer of behavioral health care in the United States, can serve as a linchpin for states seeking to improve behavioral health care for children and youth.

In the new report for the Commonwealth Fund, Manatt Health and its co-authors have developed an actionable framework and strategies for how state-level policymakers can use Medicaid and the Children’s Health Insurance Program (CHIP) to respond to the behavioral health crisis among children and youth living with complex needs—those who are stuck in emergency departments for days on end, cycling in and out of psychiatric hospitals, contemplating and sometimes attempting or completing suicide, or struggling to remain in school or to find and keep a job. The framework and strategies are rooted in a family- and community-based approach that recognizes children and youth fare best when treated in the context of their families (broadly defined) and communities, as well as when interventions build on their strengths and maximize their choices and autonomy.

Six Medicaid Strategies for Supporting Children and Youth Living With Complex Behavioral Health Needs

Manatt Health and its co-authors  have identified six Medicaid strategies that are effective in supporting young people living with complex behavioral health issues. 

Strategy 1: Establish a Clear Vision and Plan

• Engage leadership across child-serving agencies.
• Engage youth and supportive families in the policymaking process.
• Leverage data on service utilization, payment rates, workforce, and other key issues.
• Include a robust implementation, monitoring, and oversight strategy.

Strategy 2: Expand and Stabilize Medicaid Eligibility and Benefits for Children and Youth Living With Complex Behavioral Health Needs

• Expand continuous eligibility for young people with complex behavioral health needs. beyond minimum federal requirements.
• Strengthen coverage for former foster youth.
• Leverage Medicaid to reduce pressure on families to relinquish custody.
• Expand eligibility and coverage for youth involved in the juvenile justice system.
• Provide behavioral health services consistent with Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) to children in separate CHIP programs.

Strategy 3: Strengthen Prevention and Early Intervention in Treatment

• Increase take-up of behavioral health screenings.
• Allow children and youth to receive behavioral health services under EPSDT without a diagnosis.
• Cover coordinated specialty care for young adults experiencing first-episode psychosis.
• Promote integrated primary care.
• Strengthen the use of school-based services.

Strategy 4: Establish a Comprehensive, Youth-Specific Continuum of Care for Behavioral Health Conditions

• Ensure crisis services address the unique needs of young people.
• Provide intensive home-based services.
• Provide intensive care coordination to children and youth with multisystem involvement and/or co-occurring conditions.
• Offer respite services to families seeking to help their children remain in the community.
• Provide peer support services for youth and their families.
• Address young people’s health-related social needs.
• Strengthen the quality of care in residential treatment settings.

Strategy 5: Ensure Use of Evidence-Based, Community-Defined, and Culturally Responsive Assessments and Practices

• Utilize standardized tools to help determine the appropriate services for young people.
• Invest in a culturally diverse behavioral health workforce.
• Provide training and support to providers.
• Use Medicaid reimbursement strategies to increase access to linguistically and culturally appropriate care.

Strategy 6: Address the Emergency Department Boarding Crisis

• Gather and analyze data on youth boarding in emergency departments.
• Prioritize diversion through crisis services and family education.
• Permit community-based admission to inpatient facilities.
• Encourage active treatment during stays in the emergency department.
• Establish bed tracking tools and systems to identify open treatment spots.

Conclusion

Addressing the growing behavioral health crisis among children, youth, and young adults requires an urgent, concentrated effort across the health, education, justice, and child welfare sectors. Medicaid and CHIP play a particularly critical role for states seeking to strengthen their continuum of behavioral health services and supports for young people living with complex needs—including those involved in multiple systems or facing discrimination due to their race, gender, sexual identity, body weight, or culture. The six key strategies presented above are intended to directly support state-level policymakers in better leveraging Medicaid and CHIP to respond to this crisis and to ensure that the children and youth served by these public systems are set up to thrive.