MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS

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The substantial increase in Medicaid enrollment in capitated plans has raised a number of concerns regarding the delivery of child health care in the U.S. because the financial incentives to control costs inherent in such plans may elicit under-treatment and restrict access to specific treatments, services and specialty providers (Hughes and Luft, 1998). Policymakers also recognize that the shift to Medicaid managed care is likely to have the most profound impact on poor children with chronic or disabling conditions (Fox and McManus, 1998). On the other hand, capitated managed care plans offer several advantages such as care management and coordination of services. Despite the widespread growth of managed care in recent years, little research has examined the effects of managed care arrangements, in particular capitated plans, on utilization of and access to health care services by children with special health care needs (SHCN). We propose to analyze Medicaid eligibility, claims and encounter data for children with SHCN (as determined by eligibility for Supplemental Security Income (SSI)) enrolled in the DC Medicaid program. In addition, we will conduct interviews with parents of children with SHCN to evaluate access to care. Currently, some parents of children with SHCN who qualify for SSI have chosen to voluntarily enroll their child in the capitated managed care plan, while the remainder have opted to remain in the traditional fee-for-service system. As of October 2000, enrollment in capitated managed care will be mandatory for all children with SHCN. Parents will have a choice between two capitated managed care plans. The specific aims of this study are: (1) to prepare detailed case studies for the managed care plans; (2) to analyze factors determining selection of a managed care plan by the parents of children with SHCN; (3) to evaluate the effect of plan choice, child health status, and other characteristics on utilization of services based on several indicators constructed from claims data; (4) to conduct a telephone survey with a random sample of 1,200 parents of children with SHCN to elicit information on why parents have difficulties obtaining access to care for their children; and (5) to conduct a pilot study to obtain information on children's access to care from about 100 parents of children with SHCN who reside in households without telephones.