Assuring the Emotional Well-Being of Children in Child Welfare Environments through Stable Health Insurance Coverage

Principal Investigator:  Ramesh Raghavan, MD, PhD
Timeframe:  09/06 - 02/09
Affiliation:  Center for Mental Health Services Research (CMHSR)
Project Staff:     John Landsverk, PhD, Co-Investigator
                           Gregory A. Aarons, PhD, Co-Investigator
                           Peter Doré, MA, Data Manager/Analyst

Participating Organization:  DHHS Administration for Children & Families

Project Contact:  Ramesh Raghavan, MD, PhD, PI
                             Phone: (314) 935-4469
                             Email: raghavan@wustl.edu

Project Update as of 09/23/2009:

Stage: Completed

Description:

Children in the child welfare system (CWS) require an array of services to improve their emotional well-being and to increase their chances of permanency. Health insurance is the mechanism through which most children finance such services, and virtually all children in out-of-home care and most children maintained in-home are eligible for Medicaid.
The first goal of this proposal is to understand the stability of this insurance coverage over time for children in the CWS. Because insurance eligibility is linked to placement, and because Medicaid benefits end with entry into certain residential settings, unstable placement and some patterns of service utilization can cause children to lose insurance coverage. The financial gap between services covered by insurance and services that are needed but are not covered by insurance is bridged by child welfare agencies, which have emerged as major purchasers of public mental health care. The second goal of this proposal is to uncover policy solutions that can mitigate the financial burden on child welfare systems of paying for services not covered by insurance. This proposal uses four waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW), and their linkage with the Caring for Children in Child Welfare (CCCW) study, to undertake longitudinal data analysis to answer the following questions:

        (1) How does health insurance coverage vary over time for children in NSCAW, and what factors predict such variation?

        (2) Which CCCW-derived health financing policies promote stable health insurance coverage for children in NSCAW?

        (3) What are the effects of varying health insurance coverage on use of ambulatory and inpatient mental health services?