PROJECT SUMMARY
A majority of children with special health care needs (CSHCN) have behavioral health conditions. Racial
and ethnic minority CSHCN are more likely to have these health conditions and less likely to have them
diagnosed and treated compared with other CSHCN. Disparities in access to care contribute to disparities in
use of behavioral health treatment, and inadequate insurance leads to poor health outcomes among CSHCN.
Early identification and treatment for behavioral health conditions is critical to support the health and well-being
of CSHCN over their lifetimes. Yet, many racial and ethnic minority families of CSHCN experience challenges
in accessing needed behavioral health services. Disparities in behavioral health outcomes can be mitigated by
expanding insurance coverage and encouraging use of treatment. Addressing these mechanisms early in life is
critical to mitigate health disparities over the entire life course.
There is mixed evidence on the extent to which general insurance expansions reduce disparities, and
some studies even find that racial and ethnic disparities in coverage and health service use increased after
recent health insurance expansions. Other policies, including streamlined or automatic enrollment in Medicaid,
have been shown to increase Medicaid enrollment, retention and overall insurance coverage rates, but there is
no evidence about the impact of these policies on disparities in coverage or utilization for racial/ethnic minority
CSHCN, or CSHCN who have mental health conditions. Targeted interventions in expanding services may be
more effective at reducing disparities for these populations but evidence on the effects of targeted interventions
is limited. More research is needed to understand the extent to which targeted policies can reduce disparities
in health insurance coverage and behavioral health care utilization among racial/ethnic minority CSHCN.
This study will examine the effects of a targeted intervention to increase insurance coverage and
behavioral health service utilization among racial and ethnic minority CSHCN: automatic enrollment in
Medicaid via Supplemental Security Income (SSI). We propose two complementary analytic approaches, one
with nationally representative survey data and one exploiting a natural experiment in Medicaid claims data. We
will quantify the effects of Medicaid automatic enrollment via SSI on disparities in insurance coverage and
behavioral health service use among racial and ethnic minority CHSCN; identify the demographics of CSHCN
who are newly enrolled in Medicaid due to automatic enrollment policies and examine potential disparities in
their health needs; and examine how the effects on behavioral health service use, health outcomes, and
disparities in service use and outcomes evolve over time for newly enrolled CSHCN. Our findings will provide
critical insights about how targeted Medicaid automatic enrollment could improve behavioral health outcomes
for this underserved population and will contribute to broader understanding of how reducing administrative
burden may improve health equity for disadvantaged and underserved CSHCN.
