Association of Medicaid Status with Patient Mental Health Diagnosis: Data from the WA State Perinatal Psychiatry Consultation Line
Background: Despite Medicaid’s critical role in covering perinatal and behavioral health care costs, many enrollees face barriers to timely mental health diagnosis and treatment. Understanding how insurance shapes access to mental health services and how this intersects with race and ethnicity is critical in addressing inequities in perinatal mental health care. The relationship between Medicaid insurance status and mental health diagnosis during the perinatal period as well as the role of race and ethnicity in this relationship is understudied. Methods: Study sample included 1,494 patients aged 18 to 40 (764 Medicaid enrollees and 730 non-Medicaid) identified from the Perinatal Psychiatry Consultation Line 2021-2024. Diagnosis of caller reported perinatal mental health diagnosis was categorized into three mutually exclusive groups: (1) depression and/or anxiety only, (2) bipolar disorder, substance use, PTSD, ADHD, or medical conditions only, and (3) any combination of bipolar substance use, PTSD, ADHD, or medical conditions diagnosis with depression and/or anxiety. Multinomial logistic regression models were used to calculate unadjusted and adjusted odds ratios relating insurance type (Medicaid insurance status as the exposure) to caller-reported perinatal mental health diagnosis. We repeated these analyses among Black or African American patients as well as non-Hispanic White patients to assess effect modification by race/ethnicity. Results: Among patients, 491 (32.9%) had depression and/or anxiety only diagnosis; 496 (33.2%) had bipolar disorder, substance use, PTSD, ADHD, or medical conditions only diagnosis; and, 507 (33.9%) had bipolar disorder, substance use, PTSD, ADHD, or medical conditions diagnosis with depression and/or anxiety. In adjusted multinomial logistic regression models, using the depression and/or anxiety only diagnosis category as the reference group, Medicaid-enrolled patients had significantly higher odds of having a caller-reported perinatal mental health diagnosis of bipolar, substance use, PTSD, ADHD, or medical conditions only (aOR = 2.47, 95% CI: 1.85, 3.29), as well as bipolar disorder, substance use, PTSD, ADHD, or medical conditions diagnosis with depression and/or anxiety (aOR = 1.93, 95% CI: 1.46, 2.54). Among Black or African American patients, Medicaid-enrolled patients had higher odds of having a caller-reported diagnosis of bipolar, substance use, PTSD, ADHD, or medical conditions only (aOR = 2.27; 95% CI: 0.79, 6.57) and bipolar disorder, substance use, PTSD, ADHD, or medical conditions diagnosis with depression and/or anxiety (aOR = 1.43; 95% CI: 0.51, 4.06), compared to depression and/or anxiety only. However these estimates were not statistically significant. Among non-Hispanic White patients, patients with Medicaid also had higher odds of having a caller-reported diagnosis of bipolar, substance use, PTSD, ADHD, or medical conditions only (aOR = 3.48; 95% CI: 0.75, 16.23) and bipolar disorder, substance use, PTSD, ADHD, or medical conditions diagnosis with depression and/or anxiety (aOR = 2.22; 95% CI: 0.49, 10.00), compared to depression and/or anxiety only. However, these estimates were also not statistically significant. Conclusion: Perinatal individuals who have Medicaid insurance have higher odds of having a caller-reported perinatal mental health diagnosis of bipolar, substance use, PTSD, ADHD, or medical conditions only, or in combination with depression and/or anxiety, compared with depression and/or anxiety only diagnosis. It is inconclusive whether the association between insurance type and mental health diagnosis differs by race/ethnicity. Findings suggest the importance of increasing support and tailored mental health services for Medicaid-insured perinatal patients, who may be at higher risk for complex or co-occurring mental health conditions
Insurance disparities, Medicaid, Perinatal mental health, Psychiatric Epidemiology, Racial and ethnic disparities, Epidemiology
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