Psychotropic Medication Usage Among Foster and Non-foster Youth on Medicaid

Background: Previous studies report that youth in foster care covered by Medicaid receive psychotropic medication at a rate >3 times that of Medicaid-insured youth who qualify by low family income, but data on patterns of medication treatment for children in foster care are limited. While psychotropic polypharmacy, or use of multiple medications concurrently, is common in children in foster care, there is limited data to support its safety and efficacy. Out of this concerning trend, prescription monitoring guidelines and oversight rules were established, but are not uniform between states and are not well monitored. In this study, we compare psychotropic medication claims in children in foster care to children on Medicaid but not in foster care.

Methods: Healthcare claims data from two Medicaid managed care organizations (MCO) in southeast Texas were analyzed in this study – the largest MCO providing Medicaid coverage for children in the region and the single MCO providing Medicaid to children exclusively in foster care. The study included children age 1-18 years, enrolled in their respective MCO for 30 days or more, and who had at least one healthcare visit generating a Medicaid claim from July 1, 2014 to June 30, 2016. Prescription medications were categorized into six classes: alpha agonists, anxiolytics, antidepressants, antipsychotics, mood stabilizers, and stimulants. Drug classifications were based on the primary indication as approved by the Federal Drug Administration or their primary use in child psychiatry. Children with seizure and/or epilepsy diagnoses were excluded. Chi square, t-test, and Wilcoxon rank-sum analyses were used to compare outcomes between children in Medicaid and children in foster care. Comparisons were made overall and by age group.

Results: Overall, 388,914 children in Medicaid and 8,426 children in foster care were included in the study. Children in foster care were younger than children in Medicaid (mean age 7.7 years vs. 8.2 years (p < 0.000), respectively). Over one-third of children in foster care (35%) filled a prescription for a psychotropic medication as compared to 8% of children in Medicaid (p < 0.000). By class and age group, the prevalence of prescriptions for psychotropic medications was higher among children in foster care (details provided in Table 1 and Figure 1). Among children who were prescribed psychotropic medications, prescriptions were filled for a mean of 1.4 (SD 0.78) and 2.8 (SD 1.4) (p < 0.000) distinct drug classes for children in Medicaid versus children in foster care, respectively.

Conclusion: Children in foster care received significantly more psychotropic medications, overall, by age group, and by drug class. While claims data limit our understanding of the full context in which these medications were prescribed, this study demonstrates drastic differences in the use of these medications between children in Medicaid and children in foster care.