{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T18:18:18Z","timestamp":1788545898883,"version":"build-2803163510"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medicaid covers almost 40% of US children; state Medicaid programs are increasingly implementing financing and delivery system reforms through Accountable Care Organizations (ACOs). Little is known about how Medicaid ACOs are associated with outcomes for children with behavioral health conditions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between Medicaid ACO implementation and behavioral health care access, unmet mental health needs, and care experience for Medicaid-insured children with behavioral health conditions.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This repeated cross-sectional study used data from the 2016\u20132023 National Survey of Children\u2019s Health, a nationally representative household survey of US children. The study included children aged 3 to 17 years insured by Medicaid whose caregivers reported at least 1 current behavioral health condition (anxiety, depression, attention-deficit\/hyperactivity disorder, Tourette syndrome, or behavioral problems), with analyses conducted between January 2025 and February 2026. Using a difference-in-differences design, changes in outcomes before and after Medicaid ACO implementation in states that implemented Medicaid ACOs between 2017 and 2022 were compared with contemporaneous changes in states without Medicaid ACO implementation.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Medicaid ACO implementation.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were (1) having a personal physician or nurse, (2) receiving treatment from a mental health professional in the past 12 months, (3) experiencing unmet mental health needs, (4) receiving effective care coordination, and (5) receiving family-centered care.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The sample represented 29\u202f885\u202f590 children (unweighted n\u2009=\u200915\u202f783; females, 41.0%), and 9.1% resided in states with Medicaid ACO implementation. Medicaid ACO implementation was associated with higher reported unmet mental health needs (4.76 percentage points; 95% CI, 0.83\u20138.70 percentage points). Medicaid ACO implementation was not associated with having a personal physician or nurse, treatment from a mental health professional, care coordination, or family-centered care.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional difference-in-differences study of Medicaid-insured children with behavioral health conditions, Medicaid ACO implementation was not associated with broad improvements in children\u2019s behavioral health care and was associated with higher unmet needs. These findings suggest that pediatric-specific strategies and workforce investments are needed in Medicaid ACOs to support children with behavioral health conditions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.8890","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T15:30:25Z","timestamp":1776958225000},"page":"e268890","source":"Crossref","is-referenced-by-count":2,"title":["Medicaid Accountable Care Organization Implementation and Behavioral Health Care for Children"],"prefix":"10.1001","volume":"9","author":[{"given":"Chanup","family":"Jeung","sequence":"first","affiliation":[{"name":"Department of Health Policy, Management and Behavior, College of Integrated Health Sciences, State University of New York at Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Goff","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Pearlman","sequence":"additional","affiliation":[{"name":"Institute of Social Science Research, University of Massachusetts Amherst"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Sarvet","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Massachusetts Chan Medical School\u2014Baystate, Springfield"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberley H.","family":"Geissler","sequence":"additional","affiliation":[{"name":"Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School\u2014Baystate, Springfield"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"issue":"5","key":"zoi260278r5","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1007\/s10566-016-9354-1","article-title":"Strengthening the coordination of pediatric mental health and medical care: piloting a collaborative model for freestanding practices.","volume":"45","author":"Greene","year":"2016","journal-title":"Child Youth Care Forum"},{"issue":"8","key":"zoi260278r6","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1007\/s10597-024-01305-3","article-title":"Disparities in access to mental health services among children diagnosed with anxiety and depression in the United States.","volume":"60","author":"Mahmood","year":"2024","journal-title":"Community Ment Health J"},{"issue":"6","key":"zoi260278r7","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1001\/jama.2013.437","article-title":"Improving access to mental health services for youth in the United States.","volume":"309","author":"Cummings","year":"2013","journal-title":"JAMA"},{"issue":"4","key":"zoi260278r8","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1080\/01488376.2022.2088949","article-title":"Barriers to pediatric mental healthcare access: qualitative insights from caregivers.","volume":"48","author":"Toure","year":"2022","journal-title":"J Soc Serv Res"},{"issue":"1","key":"zoi260278r10","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1353\/hpu.2023.0034","article-title":"The integrated care for kids model: addressing fragmented care for pediatric Medicaid enrollees in seven communities.","volume":"34","author":"Jones","year":"2023","journal-title":"J Health Care Poor Underserved"},{"issue":"9","key":"zoi260278r13","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1377\/hlthaff.2018.05413","article-title":"Variability in states\u2019 coverage of children with medical complexity through home and community-based services waivers.","volume":"38","author":"Keim-Malpass","year":"2019","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"zoi260278r15","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1002\/nur.21731","article-title":"The roles of chronic disease complexity, health system integration, and care management in post-discharge healthcare utilization in a low-income population.","volume":"39","author":"Hewner","year":"2016","journal-title":"Res Nurs Health"},{"issue":"3","key":"zoi260278r16","doi-asserted-by":"publisher","first-page":"e582","DOI":"10.1542\/peds.2014-2725","article-title":"Cost saving and quality of care in a pediatric accountable care organization.","volume":"135","author":"Kelleher","year":"2015","journal-title":"Pediatrics"},{"issue":"4","key":"zoi260278r17","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1001\/jamainternmed.2016.9098","article-title":"Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado.","volume":"177","author":"McConnell","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"2","key":"zoi260278r18","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1111\/1468-0009.12386","article-title":"Medicaid Accountable Care Organizations in four states: implementation and early impacts.","volume":"97","author":"Rutledge","year":"2019","journal-title":"Milbank Q"},{"issue":"2","key":"zoi260278r19","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1001\/jamapediatrics.2015.3446","article-title":"Effect of attribution length on the use and cost of health care for a pediatric Medicaid Accountable Care Organization.","volume":"170","author":"Christensen","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"2","key":"zoi260278r20","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1089\/pop.2019.0241","article-title":"Effect of a Medicaid accountable care collaborative on 30-day hospital readmission rates.","volume":"24","author":"Meyer","year":"2021","journal-title":"Popul Health Manag"},{"issue":"3","key":"zoi260278r21","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1377\/hlthaff.2017.1282","article-title":"Oregon\u2019s emphasis on equity shows signs of early success for Black and American Indian Medicaid enrollees.","volume":"37","author":"McConnell","year":"2018","journal-title":"Health Aff (Millwood)"},{"issue":"7","key":"zoi260278r29","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1093\/tbm\/ibab022","article-title":"Assessing cross-sector stakeholder readiness to advance and sustain statewide behavioral integration beyond a State Innovation Model (SIM) initiative.","volume":"11","author":"Scott","year":"2021","journal-title":"Transl Behav Med"},{"issue":"5","key":"zoi260278r31","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14370","article-title":"Effects of Medicaid Accountable Care Organizations on children\u2019s access to and utilization of health services.","volume":"59","author":"Constantin","year":"2024","journal-title":"Health Serv Res"},{"issue":"6","key":"zoi260278r32","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-058268","article-title":"Cost, utilization, and patient and family experience with ACO-based pediatric care management.","volume":"152","author":"Schiavoni","year":"2023","journal-title":"Pediatrics"},{"issue":"1","key":"zoi260278r34","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1370\/afm.2759","article-title":"Difficulty obtaining behavioral health services for children: a national survey of multiphysician practices.","volume":"20","author":"Chien","year":"2022","journal-title":"Ann Fam Med"},{"issue":"5","key":"zoi260278r35","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1111\/1475-6773.13199","article-title":"How does being part of a pediatric accountable care organization impact health service use for children with disabilities?","volume":"54","author":"Song","year":"2019","journal-title":"Health Serv Res"},{"issue":"5","key":"zoi260278r37","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060584","article-title":"A multisystem approach to improving autism care.","volume":"152","author":"Habayeb","year":"2023","journal-title":"Pediatrics"},{"issue":"2","key":"zoi260278r38","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.jeconom.2021.03.014","article-title":"Difference-in-differences with variation in treatment timing.","volume":"225","author":"Goodman-Bacon","year":"2021","journal-title":"J Econom"},{"issue":"11","key":"zoi260278r40","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1001\/jamapediatrics.2024.3935","article-title":"Medicaid Accountable Care Organizations and disparities in pediatric asthma care.","volume":"178","author":"Geissler","year":"2024","journal-title":"JAMA Pediatr"},{"issue":"4","key":"zoi260278r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2024.102601","article-title":"Pediatric practices\u2019 experiences with Massachusetts\u2019 Medicaid Accountable Care Organizations.","volume":"25","author":"Jamakandi","year":"2025","journal-title":"Acad Pediatr"},{"issue":"5","key":"zoi260278r46","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1177\/10775587231168010","article-title":"Facilitators and barriers to care coordination between Medicaid Accountable Care Organizations and community partners: early lessons from Massachusetts.","volume":"80","author":"Kachoria","year":"2023","journal-title":"Med Care Res Rev"},{"issue":"5","key":"zoi260278r47","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1177\/10775587241241984","article-title":"The impact of Medicaid Accountable Care Organizations on health care utilization, quality measures, health outcomes and costs from 2012 to 2023: a scoping review.","volume":"81","author":"Holm","year":"2024","journal-title":"Med Care Res Rev"},{"issue":"2","key":"zoi260278r48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.su7102a1","article-title":"Mental health surveillance among children\u2014United States, 2013\u20132019.","volume":"71","author":"Bitsko","year":"2022","journal-title":"MMWR Suppl"},{"key":"zoi260278r1","unstructured":"Conrad? L. Medicaid\u2019s essential role in improving the mental health of America\u2019s most vulnerable youth. Commonwealth Fund. September 20, 2022. Accessed October 29, 2025. https:\/\/www.commonwealthfund.org\/blog\/2022\/medicaids-essential-role-improving-mental-health-americas-most-vulnerable-youth"},{"key":"zoi260278r2","unstructured":"Medicaid and CHIP Payment and Access Commission. Behavioral health. Accessed June 22, 2025. https:\/\/www.macpac.gov\/topic\/behavioral-health\/?"},{"key":"zoi260278r3","unstructured":"Spencer? A. Strengthening behavioral health systems through Medicaid: three strategies for state action. Center for Health Care Strategies. Accessed July 14, 2025. https:\/\/www.chcs.org\/strengthening-behavioral-health-systems-through-medicaid-three-strategies-for-state-action\/"},{"key":"zoi260278r4","unstructured":"Kaiser Family Foundation. Health insurance coverage of children 0-18. Accessed August 6, 2025. https:\/\/www.kff.org\/other\/state-indicator\/children-0-18\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D"},{"key":"zoi260278r9","unstructured":"Shippee? N, Vickery? K. The complex needs of Medicaid expansion enrollees with very low incomes. Commonwealth Fund. Accessed July 2, 2025. https:\/\/www.commonwealthfund.org\/sites\/default\/files\/2018-06\/Shippee_complex_needs_MN_Medicaid_expansion_ib.pdf"},{"key":"zoi260278r11","unstructured":"American Academy of Child and Adolescent Psychiatry. Policy statement on behavioral healthcare workforce shortage. Accessed August 6, 2025. https:\/\/www.aacap.org\/AACAP\/Policy_Statements\/2023\/Behavioral_Healthcare_Workforce_Shortage.aspx"},{"key":"zoi260278r12","unstructured":"Counts? N. Understanding the US behavioral health workforce shortage. Commonwealth Fund. Accessed October 29, 2025. https:\/\/www.commonwealthfund.org\/publications\/explainer\/2023\/may\/understanding-us-behavioral-health-workforce-shortage"},{"key":"zoi260278r14","unstructured":"MACPAC. Integration of Behavioral and Physical Health Services in Medicaid. Washington, DC: Medicaid and CHIP Payment and Access Commission; 2016. Accessed March 10, 2026. https:\/\/www.macpac.gov\/wp-content\/uploads\/2016\/03\/Integration-of-Behavioral-and-Physical-Health-Services-in-Medicaid.pdf"},{"key":"zoi260278r22","unstructured":"Lloyd? K. Shared savings for Medicaid Accountable Care Organizations: design considerations. Center for Health Care Strategies. Accessed July 2, 2025. https:\/\/www.chcs.org\/media\/Medicaid-ACO-Shared-Savings-TA-Brief_072817.pdf"},{"key":"zoi260278r23","unstructured":"Center for Health Care Strategies. State approaches for integrating behavioral health into Medicaid Accountable Care Organizations. Accessed June 17, 2025. https:\/\/www.chcs.org\/media\/ACO-LC-BH-Integration-TA_Final-9.22.pdf"},{"key":"zoi260278r24","unstructured":"National Academy for State Health Policy. Three states\u2019 strategies to improve behavioral health services delivery through Medicaid Accountable Care Programs. Accessed July 2, 2025. https:\/\/nashp.org\/three-states-strategies-to-improve-behavioral-health-services-delivery-through-medicaid-accountable-care-programs\/"},{"key":"zoi260278r25","unstructured":"Medicaid and CHIP Payment and Access Commission. March 2016 report to Congress on Medicaid and CHIP. 2016. Accessed October 29, 2025. https:\/\/www.macpac.gov\/wp-content\/uploads\/2016\/03\/Integration-of-Behavioral-and-Physical-Health-Services-in-Medicaid.pdf"},{"key":"zoi260278r26","unstructured":"Center for Health Care Strategies. Quality measurement approaches of state Medicaid Accountable Care Organization programs. Accessed July 2, 2025. https:\/\/www.chcs.org\/media\/QM_Medicaid-ACOs_matrix__050217.pdf"},{"key":"zoi260278r27","unstructured":"Rosenthal? J. Behavioral health workforce innovations: how Massachusetts and New York engage community health workers and peers to address racial and ethnic disparities. National Academy for State Health Policy. Accessed July 8, 2025. https:\/\/nashp.org\/behavioral-health-workforce-innovations-how-massachusetts-and-new-york-engage-community-health-workers-and-peers-to-address-racial-and-ethnic-disparities\/"},{"key":"zoi260278r28","unstructured":"Kaye? N, McCullough? T, Wilkniss? S. How states leverage Medicaid managed care to foster behavioral health integration. National Academy for State Health Policy. Accessed July 8, 2025. https:\/\/nashp.org\/how-states-leverage-medicaid-managed-care-to-foster-behavioral-health-integration\/"},{"key":"zoi260278r30","unstructured":"Brown? D, McGinnis? T. Considerations for integrating behavioral health services within Medicaid Accountable Care Organizations. Center for Health Care Strategies. Accessed June 22, 2025. https:\/\/www.chcs.org\/media\/ACO-LC-BH-Integration-Paper-0709141.pdf"},{"key":"zoi260278r33","unstructured":"Perrin? JM, Boudreau? AA, Homer? C. Addressing child health needs through Medicaid accountable care payment reform. Health Aff Forefront. Accessed June 19, 2025. https:\/\/www.healthaffairs.org\/doi\/10.1377\/forefront.20250319.237964"},{"key":"zoi260278r36","unstructured":"Data Resource Center for Child and Adolescent Health. Child and Adolescent Health Measurement Initiative (CAHMI) 2016-2023, Stata datasets. 2025. Accessed April 11, 2025. https:\/\/childhealthdata.org"},{"key":"zoi260278r39","unstructured":"Gardner? J. Two-stage differences in differences.? arXiv. Preprint posted online July 13, 2022. doi:10.48550\/arXiv.2207.05943"},{"key":"zoi260278r42","unstructured":"Kirchner? J, Cuneo? I. Help wanted: building a pipeline to address the children\u2019s mental health provider workforce shortage. National Governors Association. Accessed July 22, 2025. https:\/\/www.nga.org\/news\/commentary\/help-wanted-building-a-pipeline-to-address-the-childrens-mental-health-provider-workforce-shortage\/"},{"key":"zoi260278r43","unstructured":"Rosenthal? MB, Alidina? S, Ding? H, Kumar? A. Realizing the potential of accountable care in Medicaid. Commonwealth Fund. Accessed July 23, 2025. https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2023\/apr\/realizing-potential-accountable-care-medicaid"},{"key":"zoi260278r44","unstructured":"Medicaid and CHIP Payment and Access Commission. A study of safety-net providers functioning as accountable care organizations. Accessed June 16, 2025. https:\/\/www.macpac.gov\/publication\/a-study-of-safety-net-providers-functioning-as-accountable-care-organizations\/"},{"key":"zoi260278r45","unstructured":"Matulis? R, Lloyd? J. The history, evolution, and future of Medicaid Accountable Care Organizations. Center for Health Care Strategies. Accessed July 2, 2025. https:\/\/www.chcs.org\/media\/ACO-Policy-Paper_022718.pdf"},{"key":"zoi260278r49","unstructured":"Center for Health Care Strategies. Medicaid Accountable Care Organizations: program characteristics in leading-edge states. Accessed July 30, 2025. https:\/\/www.chcs.org\/media\/ACO_Design-Matrix-053014.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2848104\/jeung_2026_oi_260278_1776356618.34678.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T15:30:35Z","timestamp":1776958235000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2848104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.8890","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}