Medicaid Benefits

Are ADHD Children Getting the Treatment They Need?

A new report casts doubt on the effectiveness of the treatment received by ADHD children in the U.S.

With the enactment of the 2010 Patient Protection and Affordable Care Act, Medicare benefits have been extended to huge numbers of U.S. citizens who until now were uninsured. Among those receiving such benefits for the first time are scores of children. It’s undeniable that access to treatment is a good thing, but the quality of that treatment may not be up to scratch. The December issue of Journal of the American Academy of Child and Adolescent Psychiatry discusses the issue in detail.

Dr. Bonnie Zima and her research team investigated the treatment of 530 children with ADHD and reported on their findings in an article entitled, "Quality of Care for Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) in a Managed Care Medicaid Program." The children ranged in age from 5-11 years and received care for ADHD in primary care or specialty mental health clinics between November 2004 and September 2006 as part of a large national Medicaid managed care program. Investigators drew on a group of longitudinal analyses derived from a variety of sources: Medicaid services and pharmacy claims data, interviews with parents and children, and school records. These sources helped investigators evaluate the mental health care and clinical results for these children over the span of three 6-month periods.

Assessing the quality of care that is provided to children with ADHD is important for two reasons:

1) ADHD is among the most common of mental health disorders affecting 3%-10% of all U.S. children.

2) Over a third of national healthcare costs for pediatric mental disorders are covered by Medicaid.

Medical Necessity

Dr. Zima and her team discovered that in spite of a federal policy that imposes proof of medical necessity in order to receive Medicaid reimbursement for specialty mental health services, the severity of ADHD in the child subjects treated in primary care was similar to that of the children treated within the community mental health clinics. Still, the treatment varied so that while the majority of children in primary care were given stimulant medications and seen once or twice a year, just under a third of the children in specialty mental health programs were seen five times in a single month. Since one-quarter of the children in primary care were prescribed psychotropic medication, the infrequency of follow-up visits was deemed a glaring omission.

Care Dropouts

In both sectors there was a high rate (over one third) of care dropouts, meaning that the need of these children for mental health care remained unmet. The subjects had a poor record for refilling their stimulant prescriptions, and the clinical outcomes of the care dropouts didn’t differ from those who stayed in care.

The researchers feel these results suggest that there is a great deal of room for improvement in the care of children with ADHD. For instance, clinical severity must be in synch with the type of care provided, and better enforcement is needed in regard to follow-up visits and ensuring prescriptions are refilled. As the report states, “The enduring symptoms, impairment, and poor academic achievement of the children who remain in care and those untreated underscores the public health significance of improving the quality of care for publicly insured children with ADHD."

This post has been copied in its entirety with the kind permission of www.cognibeat.com and can be seen at http://community.cognibeat.com/2010/12/medicaid