PROJECT SUMMARY
Recent estimates suggest one in four children under age 18 have a behavioral health (BH) diagnosis such as
anxiety or depression. Limited health insurance coverage, a paucity of BH providers, and stigma associated
with BH disorders result in less than half of children receiving evidence-based treatment. Children with a high
number of adverse childhood experiences, lower socio-economic status, and who are members of minoritized
populations, including sexual and gender minority (SGM) youth, have a higher risk for BH disorders and
disparate healthcare. SGM youth have higher risk of self-injurious thoughts and behaviors compared to their
non-SGM peers. Accountable care organizations (ACOs) incentivize care integration and population health,
which promotes care coordination, linkages to community-based services, and development of interventions to
address social determinants of health. Despite widespread use of ACOs in state Medicaid programs (12 states
in 2021) and the potential for innovative reforms introduced by ACOs to improve BH care for children in
vulnerable populations, little is known about ACOs’ impact on pediatric BH care. Our parent grant (NIMH
R01MH134176) aims to identify the impacts of ACOs on BH care quality, outcomes, and experience, including
identifying heterogeneity of effects among ACOs with different organizational features. This administrative
supplement will allow us to enhance our ongoing research with additional information about the role of
Medicaid ACOs in care for SGM youth and whether organizational differences in ACOs contribute to patient
experience for Medicaid insured SGM youth with BH disorders. In response to Notice of Special Interest
(NOSI) NOT-OD-22-032, we propose to enhance our parent grant by (enhanced Aim 2) describing ACOs’
organizational approaches to care for SGM youth and (enhanced Aim 3) inclusion of SGM youth experience
with BH care in the assessment of the association of Medicaid ACO organizational features with parent/patient
experience through targeted sampling to achieve an adequate sample size. This proposed supplement is
responsive to the NOSI as our parent grant is examining access to health-related services and associated
barriers among children with BH disorders, and this supplement will allow us to enhance our existing aims with
additional data collection on ACO approaches to care for SGM populations and the addition of SGM youth
participants. The timing is ideal to complete the study within 12 months given our study team’s recent
experience with studies focusing on SGM youth populations and overlap with planned timing of parent grant
data collection activities. The proposed research is important due to ongoing inequities in access and
outcomes, including suicide, between SGM and non-SGM youth. This study will provide important insights
about whether Medicaid ACOs are addressing disproportionate burdens among SGM youth and inform future
studies on the role of delivery and financing reform in BH care for SGM youth.
