Few Medicaid-Enrolled Children Are Served by Primary Care Safety-Net Clinics

doctor and child patient
doctor and child patient, pediatric, check up
Researchers investigated federally qualified health centers and rural health clinics to address access-related barriers to mental health treatment among Medicaid-enrolled youths.

Few children and adolescents enrolled in Medicaid, who are seeking mental health treatment, are served by safety-net primary care clinics, according to study results published in Psychiatric Services.

Medicaid is the largest insurer of youths, however there are numerous barriers to mental health treatment for enrolled children and adolescents. In this study, researchers investigated federally qualified health centers (FQHCs) and rural health clinics (RHCs), termed collectively as primary care safety-net clinics, to address access-related barriers to treatments among Medicaid-enrolled youths.

The researchers evaluated Medicaid claims data from 9 states (Alabama, Georgia, Kentucky, Louisiana, Missouri, North Carolina, Tennessee, Texas, and Virginia) for 2008 to 2010. They derived a cohort of youths (n= 6433; ages 6-12) starting medication for attention-deficit/hyperactivity disorder (ADHD), as well as a cohort (n=13,209; ages 5-17) with an incident depression diagnosis. Then, they identified subjects who did not have any ADHD- or depression-related visits in a primary care safety-net clinic, had some but not a majority of primary care safety-net clinic visits, and had the majority of visits in a primary care safety-net clinic. The researchers also categorized youths based on visits to FQHCs or RHCs specifically. Bivariate and regression statistical analyses were conducted to determine correlates of mental health treatment.

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Whereas 13.5% of youths initiating ADHD medication sought mental health treatment at primary care safety-net clinics, 7.2% of the depression cohort sought treatment.  In both cohorts, living in a county with a higher percentage of its residents in an urban area was negatively associated with receiving mental health treatment in a primary care safety-net clinic (P <.05). Patients with comprehensive managed care plans were also less likely to receive the majority of their care in a safety-net setting compared to patients with fee-for-service plans (P <.001). Compared with youths who were not treated in primary care safety-net settings, those who received the majority of their treatment in these settings received lower quality care in terms of adequate follow-up care, pharmacotherapy, and psychotherapy (P <.01).

Limitations of the study included the researchers’ reliance on data over a decade old that may not be generalizable to other states.

The researchers concluded that these findings build on prior data demonstrating that children in less urbanized areas are more likely to receive their mental health care in primary care safety-net clinics. However, a very small number of Medicaid-enrolled youths seeking mental health treatment were served by these facilities in general, and quality of care appears to be a major issue.


Cummings JR, Ji X, Druss BG. Mental health service use by Medicaid-enrolled children and adolescents in primary care safety-net clinics. Psychiatr Serv. 2020 Apr 1; 71(4): 328-336.