Mental and substance use disorders often go untreated for parents receiving Medicaid

Both the mental health and drug addiction crises are rocking the country, and the effects of parents' drug use and mental illness can quickly spill over to their children. Public health experts say substance use disorders can incapacitate a previously diligent parent and lead to Child Protective Services involvement.

In 2021 alone, more than seven million children were referred to authorities over concerns of maltreatment, and more than 200,000 were removed from their homes, according to a federal report. But research shows that when parents seek treatment for psychiatric and substance use disorders, they are much less likely to experience family separation.

To calculate treatment rates among parents on Medicaid, the health insurance program for low-income people, Tami Mark, a health economist at RTI, who led the research, and her colleagues drew on a new, publicly available data set. available that used deidentified Social Security numbers to link child welfare records in Florida and Kentucky with corresponding 2020 Medicaid claims records.

For comparison, they also analyzed a random sample of Medicaid recipients who had no records in the child welfare system. (The study did not capture any counseling or medications administered outside the Medicaid system, nor any cases of undiagnosed mental health or substance use disorders.)

Among the 58,551 parents who had a child referred to social services, more than half had a psychiatric or substance use diagnosis, compared to 33% of the comparison group. About 38% of those with mental health disorders and 40% of those with substance use disorders had received counseling; about 67% of people with mental disorders and 38% of those with substance use disorders had received medications.

Norma Coe, an associate professor of medical ethics and health policy at the University of Pennsylvania who was not involved in the research, said some rates were worse than general data on Medicaid treatments, suggesting that some barriers may be specific to parents.

“In general, the United States supports parents and caregivers less than many other countries,” Dr. Coe said, “which has numerous long-lasting intergenerational effects on health and wealth.”

The study authors highlighted a number of barriers to receiving counseling and medication, including stigma, discomfort and fear of losing parental rights.

They called for better coordination between social programs, such as integrating child welfare and Medicaid data systems so it is clear when parents need to be connected to specific services.

But Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University who studies inequality, said there is another challenge: a shortage of care providers who accept patients on Medicaid, which pays rates lower reimbursement rates than private insurers.

“Access to behavioral health services is inadequate in the United States,” he said, “but it's even worse for Medicaid beneficiaries.”

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