Psychiatric Residential Treatment Facilities for Child Behavioral Health Services in North Carolina Medicaid

Background: Psychiatric residential treatment facilities (PRTFs) are a type of non-hospital inpatient treatment setting for children with severe behavioral health disorders. PRTFs are a restrictive and costly form of care that can potentially be avoided with community-based behavioral health services. Methods: Statewide Medicaid enrollment and claims data for 2015 to 2021 were used to describe PRTF utilization in North Carolina. We examined annual episodes of care in PRTFs and compared trends before and after the COVID-19 public health emergency. Results: In the study period, 7,774 children insured by North Carolina Medicaid entered a PRTF across 11,566 episodes of care at a net cost of over $230 million. In 2021, 34% of children who entered PRTFs were in foster care and 37% of children were placed in PRTFs outside of North Carolina. Limitations: Analysis limited to data collected for administrative purposes. Conclusions: Current trends indicate ongoing overrepresentation of children in foster care placed in PRTFs and increased out-of-state PRTF placements. Coordinated efforts in future research, policy, and practice are needed to determine the cause of these trends and identify solutions.