Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 29, Issue 3, 2026. Pages: 78-87
Published Online: 1 September 2026

The 2021 Child Tax Credit Expansion and Mental Health Care Use among Medicaid-Enrolled Adolescents in Ohio

Laura J. Chavez,¹* Jesse L. Hawke,² Colleen C. McLaughlin,² Cynthia A. Fontanella,³ Tyler J. Gorham,⁴ Tansel Yilmazer⁵

¹PhD, MPH, Nationwide Children’s Hospital, Center for Child Health and Outcomes Research; & The Ohio State University, College of Medicine, Department of Pediatrics, Columbus, Ohio, USA.
²PhD, Nationwide Children’s Hospital, Center for Child Health and Outcomes Research, Columbus, Ohio, USA.
³PhD, Nationwide Children’s Hospital, Center for Suicide Prevention and Research; &The Ohio State University, College of Medicine, Department
of Psychiatry and Behavioral Health, Columbus, Ohio, USA.
⁴PhD, MPH, Nationwide Children’s Hospital, IT Research and Innovation, Columbus, Ohio, USA.
⁵PhD, The Ohio State University, College of Education and Human Ecology, Department of Human Sciences, Columbus, Ohio, USA.

*Correspondence to: Laura J. Chavez, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, Ohio 43205, USA.

Source of Funding: The authors received support from the National Institute of Mental Health for the research (RF1MH133406).

Abstract

This study estimates the effects of Affordable Care Act Medicaid expansion on mental health among low-income adults overall and for Black, Hispanic, and The expanded Child Tax Credit (CTC) provided advance monthly payments to eligible U.S. families from July through December 2021 and has been linked to improvements in mental health outcomes. This study examined whether the CTC was associated with mental health-related healthcare utilization among Medicaid-enrolled adolescents in Ohio. Medicaid claims and enrollment data were analyzed using a difference-in-differences design, comparing adolescents who remained age-eligible for the CTC with a slightly older cohort that had aged out of eligibility. Outcomes included mental health-related emergency department visits, inpatient admissions, and outpatient mental health visits. CTC eligibility was not associated with significant changes in acute mental health utilization (Average marginal effect, AME= -0.0006; 95% CI, -0.0018 to 0.0006) or outpatient mental health visits (AME=0.0042; 95% CI, -0.0029 to 0.0113). Findings were similar among males and females. Results do not support an association between the 2021 CTC advance payments and adolescent mental health service utilization.

Background: The per-child advance monthly payments of the expanded Child Tax Credit (CTC) of July-December 2021 were delivered to low- and middle-income households. Previous quasi-experimental studies have identified reduced depression symptoms for adults and adolescents associated with the expanded CTC. The monthly CTC payments may have also protected against mental health-related acute care visits or improved access to outpatient treatment.

Aims of the Study: This study examined the effects of the CTC advance payments on mental health-related acute care utilization for adolescents enrolled in Medicaid in Ohio who were age-eligible for the CTC, relative to those slightly older who had aged out (i.e., turned age 18 in 2021).

Methods: The study included Medicaid claims and enrollment data for adolescents enrolled in a Medicaid Accountable Care Organization, Partners For Kids, located in central and southeastern Ohio. Difference-in-differences analyses were used, comparing post-policy differences of the advanced CTC payments to pre-policy (2019 and January-June 2021) in two age groups, for whom we expected outcome trajectories to be equivalent, but for the CTC policy change. The first group aged out of the CTC (turned 18 in 4^th quarter 2021; n=5,092), and the second was eligible (turned 18 in 1^st quarter 2022; n=5,043). We also included two similar baseline age cohorts in 2019 (n=2,972 and n=2,994). Adolescents were included if they were enrolled at least 11 months of the calendar year. The primary outcome was any mental health-related emergency department visit or inpatient stay with a primary mental health diagnosis, and the secondary measure was any mental health outpatient care visit. A random effects logistic regression model tested a two-way interaction (CTC eligibility x CTC policy period) to evaluate the effect of the policy on primary and secondary outcomes. Subgroup analyses evaluated the effects for male and female adolescents separately.

Results: Mental health-related acute care visits did not significantly change during the CTC advance payment period in 2021 (average marginal effect (AME)=-0.0006, CI -0.0018, 0.0006) for age-eligible adolescents compared to those not age-eligible. This pattern in mental-health related acute care visits was similar among male (AME=-0.0004, CI -0.0018, 0.0009) and female adolescents (AME=-0.0003, CI -0.0024, 0.0017). Mental health outpatient care visits also did not significantly change in 2021 for all three populations.

Implications for Health Policies: The results do not provide empirical support for an association between the 2021 CTC payments and mental health-related outpatient or acute care among adolescents. The amounts offered in the per-child, monthly CTC advance payments may not have been sufficient to demonstrate an association in our sample, though our analyses for a rare acute care outcome may have been underpowered. Future research is needed to further assess the relationship between income-support policies, such as monthly cash transfers, and mental health care utilization among adolescents.

Received 8 November 2025; accepted 10 August 2026