O4310: Racial and Ethnic Disparities in the Use of Primary Care and Behavioral Health Services Among Young Adults Who Age out from Foster Care

Background: Despite higher prevalence of behavioral health (BH) conditions, few young adults who age out from foster care successfully transition to adult primary care (PC) and BH services. Racial and ethnic disparities in health care use around aging out may exacerbate this lapse.

Methods: This retrospective analysis linked child welfare and Medicaid data for Coloradans, 17-23 years old, from 2014-2021. Child welfare data identified young adults aged 18 years or older who aged out from foster care by 1) emancipation or 2) living with non-parental relative or 3) running away. Young adults who aged out from foster care were matched to Medicaid-enrolled peers without foster care experience by age, income, prior Medicaid-enrollment pattern and Pediatric Medical Complexity Algorithm-defined BH condition. From Medicaid data, we categorized race/ethnicity as non-Hispanic Black, Hispanic, non-Hispanic White and Other. We excluded young adults without a BH condition and with missing or unknown race or ethnicity. We used mean per member per month claims were to estimate PC and BH service use in the 12 months before and after the month of aging out (or reference month for matched peers). With a non-Hispanic White referent, we tested for differences across race and ethnicity and over time associations using generalized estimating equations with robust variance estimates.

Results: The majority of the sample were male (57.9%), impoverished and with concurrent Pediatric Medical Complexity Algorithm-defined BH and chronic physical conditions (Table 1). Black and Hispanic young adults aging out with a BH condition had a lower probability of BH service use compared to non-Hispanic Whites before (-7.4% and -8.6%) and after (-4% and -5.2%) exit (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. Young adults of Other race and Hispanic ethnicity aging out with a BH condition had lower probability of PC use compared to non-Hispanic Whites before (-4.2% and -3.9%), but not after, exiting. PC use did not differ by race/ethnicity after the age out or reference month in either cohort.

Conclusion: The probabilities for BH and PC services use differed significantly among minoritized racial and ethnic young adults aging out from foster care with a BH condition. Addressing racial and ethnic disparities within PC and BH use among young adults preparing to age out from foster care offers an opportunity to improve pediatric to adult health care transitions. Equity-focused care transition services are needed to support young adults preparing age out from foster care.