Medicaid Spending Differences for Child/Youth Community-Based Care in California’s Decentralized Public Mental Health System

This study evaluated spending differences across counties during the decade after California decentralized its public mental health system. Medicaid data for 0–25 year olds using mental health services were collapsed to the county-year level (n = 627). Multivariate models with county fixed effects were used to predict per capita spending for community-based mental health care. While counties increased their spending over time, those with relatively low initial expenditures per user continued to spend less than counties with historically higher spending levels. Spending differences per user were most noticeable in counties with larger racial/ethnic minority populations that also had historically lower spending levels.