588 - Racial and Ethnic Disparities in the Use of Primary Care and Behavioral Health Services Among Young Adults Who Emancipate from Foster Care

Poster Number: 588
Publication Number: 588.413

James G. Kaferly, University of Colorado School of Medicine, Denver, CO, United States; Rebecca Orsi, University of Colorado Anschutz, Aurora, CO, United States; Patrick W. Hosokawa, University of Colorado - Anschutz, Aurora, CO, United States; Carter Sevick, Division of Health Care Policy and Research, Aurora, CO, United States; Liza M. Creel, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Susan Mathieu, Farley Health Policy Center, Aurora, CO, United States; De'Janae' Guillory-Williams, University of Colorado School of Medicine, Aurora, CO, United States; R. Mark Gritz, University of Colorado School of Medicine, Aurora, CO, United States

Background: Physical and behavioral health conditions (BHC) are more prevalent and primary care (PC) and behavioral health (BH) services use is higher among youth in foster care compared to non-foster care peers. Following emancipation from foster care, few young adults transition to adult health services. Race/ethnicity disparities in health care use around emancipation may limit transitions and exacerbate unmet needs.

Objective: To assess differences in and the association of race/ethnicity with PC and BH use among Medicaid-eligible, young adults with a BHC in Colorado by foster care emancipation status.

Design/Methods: The retrospective analysis linked child welfare and Medicaid data for Coloradans, 17-23 years old, from 2014-2021. Child welfare data identified young adults who emancipated from foster care. Medicaid-enrolled peers without foster care experience were matched by age, income, prior Medicaid-eligibility and diagnosed BHC by the Pediatric Medical Complexity Algorithm. From Medicaid data, we categorized race/ethnicity as non-Hispanic Black, Hispanic, non-Hispanic White and Other. Excluding missing or unknown race/ethnicity, we included 1,077 young adults who emancipated and 1,141 peers in the study. Mean per member per month claims were used to estimate PC and BH service use in the 12 months before and after the emancipation or reference month (peers). With a non-Hispanic White referent, we tested for differences across race/ethnicity and over time associations using generalized estimating equations with robust variance estimates.

Results: Among those who emancipated, BH use was higher before and after the emancipation/reference month (Table 1); yet, non-Hispanic Blacks and Hispanics had lower probability of BH service use before and after emancipation compared to non-Hispanic Whites (Figure 1). Peers had no differences by race/ethnicity before or after the reference month. Young adults who emancipated had higher PC use before the emancipation/reference month. Seen in Figure 2, those of Other and Hispanic race/ethnicity who emancipated had lower probability of PC use compared to non-Hispanic Whites before emancipation. PC use did not differ by race/ethnicity after the emancipation/reference month in either cohort.

Conclusion(s):

We found race/ethnicity disparities in PC and BH use among young adults who emancipated from foster care. While all young adults who emancipate would benefit from transition support, our findings suggest young adults of color would benefit from equity-informed transition services to ensure access to BH and PC services.