Our series of five briefs looks at the prevalence and characteristics of adolescent and young adult (youth) Medicaid enrollees with behavioral health conditions—specifically substance use disorder (SUD) and mental health conditions from before the pandemic. In this brief, we provide descriptive statistics to show the prevalence of behavioral health diagnoses among Colorado Medicaid-enrolled youth and characteristics of youth with these diagnoses in 2018, before the pandemic. We discuss how these findings relate to the prevention and treatment of behavioral health conditions and to youth well-being.

Why This Matters

Behavioral health conditions vary over time, place, and populations. Medicaid enrollees with behavioral health conditions may have increased risks of negative consequences of these conditions because of structural disadvantages, including low family wealth and historically racist policies related to substance use. Many states are already innovating their Medicaid programs to improve behavioral health–related services, including services tailored to youth. But stakeholders—including youth and their families—need more information about prevalence and characteristics of youth with behavioral health issues in their states and communities to help shape approaches to prevention and treatment and to ensure that those approaches are culturally effective and align with how stakeholders define wellness. This information can help stakeholders better assess how these issues are evolving in their states and communities.

What We Found

• About one in six adolescent (16.1 percent) and one in five young adult (19.5 percent) Medicaid enrollees in Colorado had a SUD or mental health diagnosis in 2018, representing about 55,000 Colorado youth enrollees.
• Mental health diagnoses without SUD were substantially more prevalent than SUD diagnoses (either alone or co-occurring) among both young adults (13.6 versus 5.9 percent) and adolescents (14.5 versus 1.6 percent).
• Marijuana use disorder was by far the most prevalent diagnosed SUD among adolescents (involving about three in five adolescents with a diagnosed SUD).
• For young adult Medicaid enrollees with a SUD, use disorders with marijuana, alcohol, opioids, and psychostimulants ranged from about 20 percent to 30 percent.
• Youth with a diagnosed SUD or mental health condition had high contact with health care providers in a variety of settings, including especially disproportionate contact in the emergency department (ED).

Based on these findings, we recommend several strategies:

• Increase investment in youth well-being, including implementing and bolstering programs and policies that promote social connectedness, address parent needs, support family relationships, and allow a more holistic approach to preventing and treating behavioral health conditions.
• Facilitate involvement of a diverse range of community stakeholders, including youth and families, in shaping approaches to prevention and treatment and in ensuring that these approaches are culturally effective in their communities and align with how community stakeholders define wellness.
• Increase stakeholder access to detailed statistics about youth and subpopulations of youth in states and local areas.
• Look to innovative initiatives that focus on adult ED patients with opioid use disorder for potential models for providing youth with recommended behavioral health services in the ED.
• Increase efforts to address behavioral health workforce shortages, including by potentially expanding reimbursement to peer specialists and community health workers.

How We Did It

The data for this study come from claims and enrollment data from the 2018 Transformed Medicaid Information System (T-MSIS) Analytical Files (TAFs) for Colorado. We used the Urban Institute’s Behavioral Health Services Algorithm to identify SUD and mental health conditions recorded in claims. We computed and analyzed descriptive statistics showing the prevalence and characteristics of youth with co-occurring diagnoses of SUD and a mental health condition, a SUD diagnosis only (and no mental health condition), a mental health condition diagnosis only (and no SUD), and no SUD or mental health diagnosis.