Mental Health and Substance Use Disorders Often Go Untreated for Parents on Medicaid

The New York Times

By Emily Baumgaertner

April 19, 2024

The News

For parents struggling with mental health or substance use disorders, access to treatment can often mean the difference between keeping and losing their children. But a new analysis of health and child welfare records found that a significant portion of those who were eligible for Medicaid coverage for such treatment were not getting it.

The analysis, published Friday by researchers at the nonprofit institute RTI International and the Department of Health and Human Services, found that fewer than half of parents on Medicaid who had substance use disorders and had been referred to authorities over suspicions of child abuse or neglect had received treatment.

Some Context: Experts say bad situations can often be reversed with treatment.

Both mental health and drug addiction crises have been roiling the country, and the effects of parental drug use and mental illness can quickly trickle down to their children. Public health experts say substance use disorders can incapacitate a previously diligent parent and lead to the involvement of child protective services.

In 2021 alone, more than seven million children were referred to authorities over worries of maltreatment, according to a federal report, and more than 200,000 were removed from their homes. But research shows that when parents seek treatment for psychiatric and substance use disorders, they are far less likely to experience family separation.

The Numbers: What the researchers found.

To calculate treatment rates among parents on Medicaid, the health insurance program for low income people, Tami Mark, a health economist at RTI, who led the research, and her colleagues drew from a new publicly available data set that used de-identified social security numbers to link child welfare records in Florida and Kentucky with corresponding Medicaid claims records from 2020.

For comparison, they also analyzed a random sample of Medicaid recipients who had no records in the child welfare system. (The study didn’t capture any counseling or medication given outside the Medicaid system, nor any cases of mental health or substance use disorders that were undiagnosed.)

Among 58,551 parents who had a child referred to welfare services, more than half had a psychiatric or substance use diagnosis, compared to 33 percent of the comparison group. About 38 percent of those with referrals who had mental health disorders and 40 percent of those who had substance use disorders had received counseling; about 67 percent of people with mental health disorders and 38 percent of those with substance use disorders had received medication.

Norma Coe, an associate professor of medical ethics and health policy at the University of Pennsylvania, who was not involved in the research, said some of the rates were worse than general Medicaid treatment figures, suggesting that some barriers could be specific to parents.

“In general, the U.S. supports parents and caregivers less than many other countries,” Dr. Coe said, “which has numerous and lasting intergenerational effects on health and wealth.”

What Happens Next: Examining the barriers.

The study’s authors highlighted an array of roadblocks to receiving counseling and medication, including stigma, inconvenience and the fear of losing parental rights.

They called for better coordination between social programs, such as integrating the data systems of child welfare and Medicaid so that it would be clear when parents needed to be connected to specific services.

But Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University who studies inequity, said there was another challenge: a shortage of treatment providers that will accept patients on Medicaid, which pays lower reimbursement rates than private insurers.

“Access to behavioral health services is inadequate in the United States,” he said, “but it’s even worse for Medicaid beneficiaries.”