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AJPH First Look, published online ahead of print Feb 28, 2007
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November 2007, Vol 97, No. 11 | American Journal of Public Health 1951-1956
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.094771

HEALTH POLICY AND ETHICS

Effects on Outpatient and Emergency Mental Health Care of Strict Medicaid Early Periodic Screening, Diagnosis, and Treatment Enforcement

Lonnie R. Snowden, PhD, Mary C. Masland, PhD, Neal T. Wallace, PhD and Allison Evans-Cuellar, PhD

Lonnie R. Snowden is with the School of Social Welfare and the Center for Mental Health Services Research, Institute of Personality and Social Research, University of California, Berkeley. Mary C. Masland is with the Center for Mental Health Services Research, Institute of Personality and Social Research, University of California, Berkeley. Neal T. Wallace is with the Division of Public Administration, Mark O. Hatfield School of Government, Portland State University, Portland, Ore. Allison Evans-Cuellar is with the Department of Health Policy and Management, Joseph P. Mailman School of Public Health, Columbia University, New York, NY.

Correspondence: Requests for reprints should be sent to Lonnie R. Snowden, PhD, School of Social Welfare, University of California, Berkeley, 200 Haviland MC 7400, Berkeley, CA 94720–7400 (e-mail: snowden{at}berkeley.edu).

We investigated enforcement of mental health benefits provided by California Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Enforcement, compelled by a consumer-driven lawsuit, resulted in an almost 4-fold funding increase over a 5-year period.

We evaluated the impact of enforcement on outpatient treatment intensity (number of visits per child) and rates of emergency care treatment. Using fixed-effects regression, we examined the number of outpatient mental health visits per client and the percentage of all clients using crisis care across 53 autonomous California county mental health plans over 32 three-month periods (quarters; emergency crisis care rates) and 36 quarters (out-patient mental health visits).

Enforcement of EPSDT benefits in accordance with federal law produced favorable changes in patterns of mental health service use, consistent with policy aims.






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