Early school Medicaid expansions and health services for children with parental opioid use disorder

• In Event: Investigation of Policies for Increasing Children’s Receipt of Medicaid-funded School-based Health Services

Abstract

Importance: Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the lifecourse. Yet, these children are less likely to receive comprehensive, ongoing healthcare, and their parents are more likely to report barriers to access healthcare for their children. School-based health services have potential to overcome some of these healthcare access barriers, including parental burden, transportation, time, costs, and healthcare discontinuity. In 2014, Medicaid revoked its longstanding “Free Care Rule,” expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule.

Objective: Estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder.

Design: Longitudinal study using nationwide Medicaid claims data and a difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014-2019.

Participants: Medicaid-enrolled children aged 5-18 who experienced parental opioid use disorder at any point between ages 0-18.

Exposures: Compare the outcomes of children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates.

Main Outcomes and Measures: Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency room visits, and inpatient hospital stays.

Results: The sample comprised 6,628,404 person-years from 1,700,304 children. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (P<0.05). Growth was primarily driven by school claims for nursing services (7.4 percentage points, P<0.05) and for Early and Periodic Screening, Diagnosis, and Treatment Program services (8.6 percentage points, P<0.05). We also documented reductions in emergency room visits among children ages 5-11 (-1.8 percentage points, P<0.05).

Conclusions and Relevance: Given the complex health and healthcare needs of children growing up amid the opioid crisis, integrating healthcare into schools may offer a promising policy solution. 

Authors

• Angelica Meinhofer, Weill Cornell Medicine
  Presenting Author

• Lindsey Rose Bullinger, Georgia Institute of Technology
  Non-Presenting Co-Author

• Caroline Kelly, The University of Chicago
  Non-Presenting Co-Author

• Maria D. Fitzpatrick, Cornell University
  Non-Presenting Co-Author