Brief Substance Use Disorder and Mental Health Diagnoses among Medicaid-Enrolled Youth before the Pandemic: Findings from Washington, DC
Victoria Lynch, Lisa Clemans-Cope
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This is one in a series of five briefs that looks at the prevalence and characteristics of young adults (youth) Medicaid enrollees with behavioral health conditions—specifically substance use disorder (SUD) and mental health conditions from before, during, or after the pandemic. In this brief, we provide descriptive statistics to show the prevalence of behavioral health diagnoses among Washington, DC, 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. The behavioral health of Washington, DC, youth Medicaid enrollees may have been especially impacted by the pandemic given lengthy school closures and business restrictions. Medicaid enrollees with behavioral health conditions may also 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 five adolescent (20.5 percent) and one in five young adult (17.2 percent) Medicaid enrollees in Washington, DC, had a SUD or mental health diagnosis in 2018, representing about 9,200 Washington, DC, youth enrollees.
  • Mental health diagnoses without SUD were substantially more prevalent than SUD diagnoses (either alone or co-occurring) among both young adults (12.4 versus 4.8 percent) and adolescents (19.2 versus 1.3 percent).
  • Marijuana use disorder was by far the most prevalent diagnosed SUD among adolescent and young adult Medicaid enrollees with a SUD.
  • Youth with a diagnosed SUD or mental health condition had high contact with health care providers in a variety of settings, including disproportionate contact in the emergency department (ED) and schools.

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 comes from claims and enrollment data from the 2018 Transformed-Medicaid Information System (T-MSIS) Analytical Files (TAFs) for Washington, DC. 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.

Research Areas Children and youth Health and health care Greater DC
Tags Mental health Substance use Opioid crisis
Policy Centers Health Policy Center
Research Methods Quantitative data analysis
States District of Columbia
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