Public Insurance Eligibility Thresholds and Receipt of Mental Health Services among Childen from Households with Low Incomes.

INTRODUCTION: Only half of U.S. children with mental health conditions receive treatment annually, and children from lower-income households face greater barriers to treatment. Medicaid and the Children's Health Insurance Program (CHIP) facilitate children and families to access mental health services by providing government-funded insurance coverage. However, household income eligibility thresholds for children in Medicaid and CHIP vary greatly across states, and children from low-income households in states with a higher threshold are more likely to access healthcare. Using national data, we examine the relationship between eligibility thresholds across Medicaid and CHIP and receipt of mental health services among children from low-income households.

METHODS: We used data from the 2016-2020 National Survey of Children's Health to identify children ages 6-17 with household incomes below 400% of the federal poverty line. We conducted multivariable logistic regressions to estimate the associations between eligibility thresholds and children's (1) use of any mental health services as well as (2) caregiver-reported unmet mental health need in the past year.

RESULTS: Controlling for child, family, and state characteristics, we did not find a significant relationship between eligibility thresholds and use of any mental health services. However, we found that a one standard deviation increment in the eligibility threshold above the mean was associated with 20% lower odds of caregiver-reported unmet mental health need (OR: 0.79, p < 0.01).

DISCUSSION: More generous eligibility thresholds in Medicaid and CHIP are associated with less unmet need for mental health care among children from families with low incomes.