Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 20, Issue 3, 2017. Pages: 137-145
Published Online: 1 September 2017

Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities

Lonnie R. Snowden,¹ Neal Wallace,² Kate Cordell,³ Genevieve Graaf^3*

¹University of California, Berkeley, School of Public Health, Berkeley, CA, USA
²Oregon Health and Science University, Portland State University, School of Public Health, Portland, OR, USA
³School of Social Welfare, University of California, Berkeley, CA, USA

*Correspondence to: Genevieve Graaf, School of Social Welfare, University of California, Berkeley, CA, USA.
Tel. +1-217-390 4395
E-mail: ggraaf@berkeley.edu

Source of Funding: National Institute of Mental Health Grant # NIMH R01 MH 083693.

Abstract

Settlement of California Medicaid’s EPSDT lawsuit provided county mental health treatment systems state funding for children’s services without the usual requirement for matching county funds. Using expenditures as an indicator of mental health treatment and participation in services, the study evaluates whether expanded EPSDT funding disproportionately benefited Latinos and, accordingly, achieved Latino-White inequality reduction, especially where county mental health plan administrators made use of CBOs with culturally sensitive mental health programs. The infusion of funds disproportionately affected Latino children immediately but did not translate into a long-term trend. For addressing Latino-Whites expenditure disparities, counties in the study were shown to be better equipped if they collaborated with organizations offering culturally and linguistically sensitive programming. This study demonstrates that increases in funding and reductions in local cost-sharing, and the leveraging of local linguistically and culturally sensitive programs, hold potential for reducing mental health access and utilization inequities for this population.

Background: Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services.

Aims: We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites.

Methods: Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs.

Results: Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities.

Discussion: EPSDT expanded funding increased proportional expenditures for Whites absent cultural and language-sensitive treatment programs. The programs moderate, but do not overcome, entrenched expenditure disparities. These findings use investment in mental health services for Latino populations to indicate treatment access and utilization, but do not explicitly reflect penetration rates or intensity of services for consumers.

Implications for Policy: New funding, along with an expectation that Latino children's well documented mental health treatment disparities will be addressed, holds potential for improved mental health access and reducing utilization inequities for this population, especially when specialized, culturally and linguistically sensitive mental health treatment programs are present to serve as recipients of funding.

Implications for Research: To further expand knowledge of how federal or state funding for community based mental health services for low income populations can drive down the longstanding and considerable Latino-White mental health treatment disparities, we must develop and test questions targeting policy drivers which can channel funding to programs and organizations aimed at delivering linguistically and culturally sensitive services to Latino children and their families.

Received 23 November 2016; accepted 14 July 2017