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Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD

  • Sarah C. BlakeEmail author
  • Minna Song
  • Laura Gaydos
  • Janet R. Cummings
Original Article
  • 4 Downloads

Abstract

This qualitative study describes how Medicaid policies create challenges for the delivery and receipt of mental health treatment for low-income youth in Georgia. We conducted focus groups with caregivers of Medicaid-enrolled children with ADHD and semi-structured interviews with providers and administrators at four safety net clinics that provided mental health care to these youth. Stakeholders reported that prior authorization policies for psychosocial services, restrictiveness of preferred drug lists, and changes in preferred drug lists in Medicaid plans created barriers to treatment continuity and quality for youth with ADHD and led to more administrative burden for safety-net clinics serving these youth.

Keywords

ADHD treatment Children’s mental health services Medicaid Safety-net Qualitative research 

Notes

Acknowledgements

The authors would like to thank parents, providers, and administrators for their participation in this study. We are also grateful to Rachel Stover and Lucy Rabinowitz for their assistance with this project.

Funding

This work was supported by a grant from the National Institute of Mental Health (Grant No. K01MH095823, PI Janet R. Cummings). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

Dr. Blake declares that she has no conflict of interest. Ms. Song declares that she has no conflict of interest. Dr. Gaydos declares that she has no conflict of interest. Dr. Cummings declares that she has no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Emory University Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Policy & Management, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Department of Behavioral Health Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Lombardi Comprehensive Cancer CenterGeorgetown UniversityWashington, DCUSA

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