Five insurance companies now account for about half of the Medicaid managed care market, and adolescents enrolled in their plans often receive behavioral healthcare differently than those in other managed care organizations, according to a study published Aug. 5 in Health Affairs.
The study, conducted by Portland-based Oregon Health & Science University researchers, analyzed Medicaid claims for millions of Medicaid-enrolled youths in 2022, the latest year available. Researchers said the findings warrant closer scrutiny as a growing share of the Medicaid program is administered through a small number of national managed care organizations.
Here are four things to know:
1. Market consolidation has accelerated. In 2006, locally governed plans covered most Medicaid managed care enrollees. By 2022, five national firms — Centene, Elevance Health, UnitedHealth Group, Molina Healthcare and CVS Health — accounted for about half of the market.
2. Screening rates were lower. Researchers found Medicaid-required screening for children’s physical and behavioral health needs was consistently lower among plans owned by the five firms than among other managed care organizations.
3. Medication was more likely without therapy. Adolescents enrolled in plans owned by four of the five firms were more likely to receive a psychotropic prescription without a recorded psychotherapy visit, a pattern the researchers said clinical guidelines generally flag as a concern outside uncomplicated cases.
4. Acute mental healthcare use was higher. For most of the five firms, enrollees had higher rates of mental health-related emergency department visits and psychiatric inpatient admissions. Researchers said they could not determine the cause but noted it may reflect limited access to outpatient behavioral healthcare.
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