Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD

• Type of Material: Article
• Authors: Sarah Blake, Emory University; Minna Song, Emory University; Laura Gaydos, Emory University; Janet Cummings, Emory University
• Language: English
• Date: 2019-09-01
• Publisher: Springer
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer Science+Business Media, LLC, part of Springer Nature 2019.
• Final Published Version (URL): http://dx.doi.org/10.1007/s10488-019-00937-y
• Title of Journal or Parent Work: Administration and Policy in Mental Health and Mental Health Services Research
• Volume: 46
• Issue: 5
• Start Page: 580
• End Page: 595
• Grant/Funding Information: This work was supported by a grant from the National Institute of Mental Health (K01MH095823, PI: Janet R. Cummings).
• Keywords: Access; Disorders; Life Sciences & Biomedicine; Qualitative research; ADHD treatment; Children's mental health services; Mental health services; Health Care Sciences & Services; Science & Technology; Public, Environmental & Occupational Health; Children; Impact; Massachusetts; Safety-net; Health Policy & Services; Medicaid; Patterns; Managed care; Implementation
• Research Categories: Health Sciences, Public Health; Health Sciences, Mental Health; Psychology, Cognitive; Health Sciences, Health Care Management

Abstract

This qualitative study describes how Medicaid policies create challenges for the delivery and receipt of mental health treatment for low-income youth in Georgia. We conducted focus groups with caregivers of Medicaid-enrolled children with ADHD and semi-structured interviews with providers and administrators at four safety net clinics that provided mental health care to these youth. Stakeholders reported that prior authorization policies for psychosocial services, restrictiveness of preferred drug lists, and changes in preferred drug lists in Medicaid plans created barriers to treatment continuity and quality for youth with ADHD and led to more administrative burden for safety-net clinics serving these youth.