Effect of Medicaid Eligibility Category on Racial Disparities in the Use of Psychotropic Medications Among Youths

Johns Hopkins University, Baltimore, Maryland, United States
Psychiatric Services (Impact Factor: 2.41). 03/2005; 56(2):157-63. DOI: 10.1176/
Source: PubMed


This study sought to determine the degree to which Medicaid eligibility categories modify disparities between black and white youths in the prevalence of psychotropic medication.
Computerized claims for 189,486 youths aged two to 19 years who were continuously enrolled in a mid-Atlantic state Medicaid program for the year 2000 were analyzed to determine population-based annual prevalence of psychotropic medication by race or ethnicity and by whether the youths were eligible for Medicaid for reasons of family income, disability, or foster care placement. Logistic regression was used to assess the interaction of eligibility category and race.
The mean annual prevalence of psychotropic medication for the population was 9.9 percent. The prevalence was 2.17 times higher for white youths than for black youths (16.5 percent compared with 7.6 percent). However, within eligibility categories, the white-to-black disparity was 3.8 among youths who were eligible for Medicaid because their family income was below the federal poverty level and 3.2 for youths enrolled in the State Children's Health Insurance Program.
Medicaid eligibility categories had a profound impact on the racial disparity associated with the prevalence of psychotropic medications for youths. Eligibility category should be taken into account when ascertaining the role of access, undertreatment, and culture in disparities in mental health treatment.

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    • "Studies based on Medicaid claims have not been entirely consistent in demonstrating differences between foster care, SSI and low-income groups, possibly because of state-level variation in eligibility determinations, the extent of managed care penetration in Medicaid service delivery, or assessment of mental health need itself (Raghavan et al. 2010). According to Medicaid data from one mid-Atlantic state, rates of mental disorder and psychiatric medication were higher among youth in foster care than either of the other eligibility statuses (dosReis et al. 2001; Zito et al. 2005). However, other studies have shown greater similarities between foster care and SSI groups. "
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    • "Race/ethnicity was categorized as Caucasian, African American, or other. Consistent with other analyses of Medicaid-enrolled individuals (Zito et al. 2005), we categorized individuals into Medicaid eligibility categories according to whether they were Medicaid eligible as a result of general assistance , medical or mental health disability (e.g., Supplemental Security Income [SSI]), or income (e.g., Temporary Assistance to Needy Families [TANF]). Individuals were categorized as living in an urban area if their county of residence had a population density of greater than 1,000 individuals/square mile. "
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    • "Race/ethnicity was categorized as Caucasian, African-American, Latino, or other. Consistent with other analyses of Medicaidenrolled populations (Zito et al., 2005), individuals were categorized into Medicaid eligibility categories according to whether their Medicaid eligibility resulted from medical or mental health disability (e.g. Supplemental Security Income (SSI) or Supplemental Security Income with Medicare (SSIM)), income (e.g. "
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