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Author ORCID Identifier

https://orcid.org/0009-0006-1569-0026

Date Available

6-7-2026

Year of Publication

2026

Document Type

Capstone

Degree Name

Doctor of Social Work (DSW)

College

Social Work

Department/School/Program

Social Work

Faculty

Dr. Laura Escobar-Ratliff

Abstract

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, hospitals, schools, and community programs routinely see the effects of limited specialist availability, inconsistent coverage, and delayed diagnosis. Understanding how Medicaid rules, income, and treatment standards interact is essential for improving access and outcomes for individuals with eating disorders.

This capstone brings together findings from three integrated scholarly products to examine the structural factors that shape access to ED care, engagement, and treatment pathways for Medicaid insured individuals. The systematic literature review identifies consistent disparities in diagnosis timing, provider availability, and approval of recommended services, showing predictable gaps across the treatment process. These findings demonstrate that Medicaid insured individuals encounter barriers at every stage of care, from initial identification to authorization of recommended treatment level.

The conceptual analysis explains how Medicaid policies contribute to these gaps by examining payment rates, prior authorization rules, and coverage decisions that diverge from clinical guidelines for ED care. It shows that these barriers come from how Medicaid is set up, not from anything clients or providers are doing wrong, making it clear it is the way Medicaid policies are designed that affects who can get ED treatment, leaving people with eating disorders at a disadvantage when they rely on publicly funded insurance. The practice application paper translates these findings into strategies that can be used in real world settings. These strategies include standardized assessment pathways, expanded training for Medicaid accepting ED providers, multidisciplinary care models, and policy reforms that support timely and evidence-based ED treatment. The paper also recommends fairness focused quality measures to track ED care access, care timeliness, and outcomes for Medicaid insured individuals.

Together, these three papers offer a clear understanding of the system level problems that limit access to ED treatment for people who rely on Medicaid and outline practical and policy based solutions to improve equity. This capstone shows that meaningful progress requires changes to Medicaid policies, increased availability of trained providers, and ongoing monitoring of fairness in treatment access. The project provides social workers and policymakers with concrete strategies to improve care for adolescents and young adults with eating disorders who depend on Medicaid.

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