(B-116) Antipsychotic Use Before and After Foster Care Enrollment Among Youth in Medicaid

Background: Real-world evidence of changes in antipsychotic use before and after foster care (FC) enrollment can shed light on the clinical and social factors affecting use among US youth in Medicaid. To date, few studies have examined changes in antipsychotic use as youth transition to FC.

Objectives: We describe changes in antipsychotic prevalence before and after an initial FC enrollment among youths in Medicaid.

Methods: This retrospective study used 2015-2020 Medicaid service and prescription claims data from one US state. Our study population includes 2-17 years-old who received mental health (MH) services, defined by any visit associated with a psychiatric diagnosis, MH procedure, or psychotropic dispensing. Our analytical cohort is youths with an initial FC enrollment between 7/1/15-6/30/20 who had at least 6 months of Medicaid enrollment before the initial FC enrollment for eligibility reasons of low-income (up to 200%-US federal poverty level (FPL)), children’s health program (up to 300%-FPL), or disability. We estimated the prevalence of antipsychotic use in two periods: 6 months before initial FC and the months during initial FC. We assessed changes between periods using linear probability models with robust standard errors. Models were adjusted by demographic and eligibility characteristics, MH diagnoses, and psychotropic use in the 6 months preceding the initial FC. Subgroup analysis by key characteristics assessed variations in prevalence changes after initial FC enrollment.

Results: Our analytical cohort included 4,834 youths, of whom 895 (18.5%) used antipsychotics during the study period. Among antipsychotic users, 119 (13.3%) had evidence of use only before FC, 320 (35.8%) of use only after FC, and 456 (50.9%) of use before and after FC. The prevalence of antipsychotics after FC (14.4%) vs. before FC (10.6%) was significantly higher by 4.2% points (95% confidence interval: 3.3%-5.0%). The subgroup analysis shows that antipsychotic use was significantly higher after FC than before by 2.0% points among 2-5 years-olds, by 4.6% points among 6-12 years-olds, and by 4.9% points among 13-17 years-olds. We observed similar increases of 4.2% points among females and males. By Medicaid eligibility preceding FC, antipsychotic use was significantly higher after vs. before FC by 4.3% points among youth with low-income eligibility and 8.5% points for those in the children’s health program, but not significantly different (2.1% points) among those with disabled eligibility.

Conclusions: Antipsychotic use among youth enrolled in Medicaid increased after initial FC enrollment. Variation by age and the type of eligibility before FC may reflect differential mental health care needs of youth transitioning to FC.