Corporate Consolidation And The Youth Mental Health Crisis: Evidence From Medicaid Managed Care In 2022

Medicaid managed care organizations serve as the primary vehicle for delivering behavioral health services to low-income youth. However, market consolidation has shifted enrollment toward a handful of large national parent firms. Understanding the implications of this shift is critical for identifying and closing gaps in adolescent mental health services. Using national Medicaid claims data from 2022, we examined the associations between managed care organization ownership by five major parent firms and measures of youth mental health service use and provider composition. Managed care organizations owned by large national parent firms were characterized by lower mental health screening rates and, for most firms, higher use of emergency department, inpatient, and medication-based care, including psychotropic prescribing without psychotherapy. Provider composition also varied by firm, suggesting differences in how these organizations structure their behavioral health networks, with some relying more heavily on psychiatrists and psychologists and others depending more on master's-level therapists. The growing influence of large national parent firms in shaping behavioral health access for Medicaid-enrolled youth underscores the need for closer scrutiny of how managed care structures serve youth with significant mental health needs.