Children's Mental Health Benchmarking Report Project, Fourth Year Report

The President's New Freedom Commission on Mental Health emphasized the need to reduce the fragmentation in public mental health services resulting from the administration of those services by many separate state agencies. Nowhere is this fragmentation more of a problem than with children's mental health services. While children's 'systems of care' projects have addressed this fragmentation through their financing and service strategies, progress has been limited beyond the boundaries of the grant sites. For the past four years, the Children's Mental Health Benchmarking Project, sponsored by the Annie E. Casey Foundation with support from the Center for Health Care Strategies and the Robert Wood Johnson Foundation, has collected data from state Medicaid agencies and Mental Health Authorities on access to, utilization of and expenditures on children's mental health services. While the principal goal of the project has been to provide states and counties with benchmarks for performance improvement, it has also documented the scope and impact of the fragmentation in the 'system' of care for children with mental health needs.

Medicaid and Mental Health Authority (MHA) systems constitute the primary sources of children's mental health care and serve an overlapping clientele. Medicaid agencies are responsible for serving three primary groups of children: those who are eligible on the basis of low family income, those in state custody (primarily foster children), and those that meet criteria for disability. These three distinct subgroups have differing service needs, and in general foster and disabled children need the more intensive services. The State Children's Health Insurance Program (SCHIP) also serves income eligible children, and many states administer it jointly with their Medicaid program. The priority population for MHAs is children with serious emotional disturbance (SED). Because most of these children meet at least one category of Medicaid eligibility, Medicaid finances many of the services they need. MHA resources and sliding fees generally cover most of the remaining children as well as services not covered by Medicaid or private insurance, although their total dollar amount is generally quite small relative to Medicaid expenditures and may not meet all the need. (Excerpt)