The Status of TennCare Children & Adolescents
 Article Prepared By Craig Anne Heflinger, Ph.D.- Principal Investigator
with Andrea Flowers - Data Disseminator

Since 1994, Tennessee has operated a managed care Medicaid program known as TennCare. In 1996 TennCare Partners became the managed care carve-out program that funds behavioral health benefits (i.e., mental health and substance abuse services) for the state's special populations.

This article focuses on one aspect of the IMPACT Study¹ and includes findings related to behavioral and physical health status, services received, access to care and parent satisfaction with TennCare services. The information came from interviews with parents/caregivers who answered questions about their children and adolescents. The focus of the study was on children with serious emotional disorder (SED), but data from a representative sample of TennCare children was also included. 

The IMPACT Study found that children who were TennCare beneficiaries demonstrated high levels of mental health problems. Twenty-six percent of the TennCare total child population met the federal SED criteria at the time of the interview. This translates to over 80,000 children ages 4 through 17 across Tennessee. TennCare children with SED also seemed to have more health problems than other TennCare children. Forty-six percent of youth with SED were reported to have at least one co-occurring chronic health problem (e.g., asthma, allergies, epilepsy). In addition, a large majority (81%) of TennCare youth, ages 11 through 17, also reported drug and/or alcohol use during their lifetime. An estimated one-third of these youth would benefit from screening for a co-occurring mental health and substance abuse disorder.

Findings suggest that TennCare children were able to access the behavioral health services more often compared to national reports. Overall, 18% TennCare children and 45% of those with SED received some form of specialty mental health service (i.e., provided by trained mental health professionals). It should also be noted that more than one in five children (22%) were on medication for emotional and/or behavioral problems in the six months prior to the interview. Among children with SED, 50% were taking this type of medication. Tennessee’s community mental health centers (CMHCs) were the most common providers for mental health services. In the six-month period preceding the interview, 62% of youth who received any formal behavioral health service had been seen at a CMHC. Parent/caregivers reported being satisfied with a many aspects of their children's behavioral health services, especially the family-friendliness of staff. However, of the children with SED who received a behavioral health service, 35% of the parents/caregivers reported that they did not think the services were helping their child.

TennCare children were able to access medical care, as well. Ninety-five percent of the parents/caregivers interviewed were able to name a specific source of care and most were individual physicians or clinics. This suggests that TennCare is coming close to its goal of linking each beneficiary with a primary health care provider. Parents/caregivers reported being most satisfied with coverage for preventive care and illness visits. It is notable, however, that parents/caregivers of youth with SED were less satisfied with both behavioral and physical health services received through TennCare than were parents/caregivers of children without SED.

One of the biggest issues facing children on TennCare was the gap in service delivery for youth who expressed behavioral health problems. Fifty-five percent of children with SED did not receive specialty mental health services. In addition, although the families of children with SED demonstrated high levels of need, few supports were available for them through the behavioral health system.

More appropriate resources are needed to screen, identify, and treat children with SED.  Increased efforts to train physicians and other providers in behavioral health screening techniques are needed.  Providers in the TennCare Behavioral Health Organization (BHO) networks need training and incentives to address individuals' behavioral health care needs. Families of children with emotional and behavioral challenges also need support services. Services for these youth and their families must include a coordinated system that includes all aspects of the youth’s life in order to address the total needs of these youth and family.

¹ This article is based on one of several reports from the IMPACT Study, conducted by Vanderbilt University's Center for Mental Health Policy in conjunction with Tennessee Voices for Children, the Tennessee Commission on Children and Youth, and Mississippi Families as Allies.  The IMPACT Study focused on mental health and substance abuse issues of school-aged Medicaid children and adolescents in Tennessee and Mississippi, and was funded by the United States Department of Health & Human Services (USDHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study to examine the impact of Medicaid managed care on vulnerable populations. 

©TVC 2001-2002