Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD
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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.
KeywordsADHD treatment Children’s mental health services Medicaid Safety-net Qualitative research
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.
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.
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 was obtained from all individual participants included in the study.
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