Most Children Enrolled in Medicaid Did Not Receive Timely Suicide-Related Followup Care
Learn how the AI-generated research projects were createdOverall Conclusion
Timely followup care after pediatric suicidal thoughts or behaviors is not consistently achieved across states; about half of cases did not have a followup visit within 7 days and 21 percent had none within 60 days; shortages of behavioral health providers and difficulties connecting children to care are key barriers; CMS concurred with the recommendation to provide targeted technical assistance to low-performing states.
Source Document
Audit Scope
Analysis of Transformed Medicaid Statistical Information System (T-MSIS) data from FY 2023 for 54 states and territories, including children aged 10–17 hospitalized or visiting an ED for suicidal thoughts or behaviors who were continuously enrolled in Medicaid or CHIP for at least 60 days post-discharge; evaluation of followup care timing, provider type, and state variation; includes appendices with followup rates by state and by child/plan characteristics.
Key Findings Summary
In 2023, 224,759 Medicaid-enrolled children aged 10–17 were hospitalized or visited the emergency department for suicidal thoughts or behaviors; the analysis included 258,458 unique hospitalizations or emergency department visits (cases).
In 50 percent of reviewed cases, children did not receive a followup visit within 7 days of the hospitalization or ED visit for suicidal thoughts or behaviors.
In 21 percent of cases, there were no followup visits in the 60 days after discharge.
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AI-Assisted
AI Scope Summary
This audit examined the type and timeliness of followup care for children aged 10–17 enrolled in Medicaid/CHIP who were hospitalized or ED-treated for suicidal thoughts or behaviors in FY 2023, assessed state variation and access barriers, and concluded that timely followup is inconsistently provided; it recommends CMS to assist low-performing states and promote brief interventions to improve followup rates.
AI-Generated Insight
The report highlights substantial gaps in timely suicide-related followup care for Medicaid/CHIP-enrolled youth, underscoring the need for CMS to expand access, reduce provider shortages, and promote brief, bridging interventions to ensure continuity of care.
Audit Objectives
To examine the type and timeliness of followup care, if any, provided to children enrolled in Medicaid or CHIP who received treatment for suicidal thoughts or behaviors.
To determine whether rates of timely followup care varied by State for children enrolled in Medicaid or CHIP who received treatment for suicidal thoughts or behaviors.
To identify access issues and best practices regarding timely followup care for children enrolled in Medicaid or CHIP who received treatment for suicidal thoughts or behaviors.
Audit Findings (5)
In 2023, 224,759 Medicaid-enrolled children aged 10–17 were hospitalized or visited the emergency department for suicidal thoughts or behaviors; the analysis included 258,458 unique hospitalizations or emergency department visits (cases).
In 50 percent of reviewed cases, children did not receive a followup visit within 7 days of the hospitalization or ED visit for suicidal thoughts or behaviors.
In 21 percent of cases, there were no followup visits in the 60 days after discharge.
Among followup visits that occurred, 71 percent were with behavioral health providers; counselors accounted for 28 percent of visits, social workers 22 percent, psychiatrists/neurologists 19 percent, psychologists 17 percent, and psychiatric nurse practitioners 5 percent; the remaining 29 percent were with other providers.
Subject matter experts attributed the lack of timely followup visits to behavioral health provider shortages and difficulties connecting children to care.
Recommendations (2)
Assist low-performing States to better ensure that children at risk of suicide receive timely followup care.
CMS should provide additional technical assistance to States, focusing on the 24 States identified in the report where more than half of children do not receive followup within 7 days, through webinars and periodic calls; share promising practices and resources for engaging non-behavioral health providers and for implementing brief interventions such as caring contacts and safety planning.