Child/Adolescent Health

Caregivers of children with special health care needs rate Medicaid managed care as having better care access than fee-for-service

Most States have been reluctant to enroll children with special health care needs (SHCN) into Medicaid managed care plans. This stems from concerns that capitated plans (plans are reimbursed per patient, regardless of medical resources used) have financial incentives to hold down costs by limiting access to specialty providers, therapeutic care, and other ancillary services. However, caregivers of children with SHCN in the District of Columbia rated a partially capitated Medicaid managed care (MC) plan better than a traditional fee-for-service (FFS) plan in providing these children with access to care.

Jean M. Mitchell, Ph.D., of the Georgetown Public Policy Institute, and Darrell J. Gaskin, Ph.D., of Johns Hopkins University, interviewed a random sample of 1,088 caregivers of children with SHCN enrolled in the Medicaid program of the District of Columbia. After controlling for the potential selection bias linked to plan choice and other factors, they found that caregivers of children in the FFS plan were significantly more likely to rate several dimensions of care access as either fair or poor than caregivers of children enrolled in the partially capitated MC plan. These included access to specialists' care, access to emergency room care, convenience of the doctor's office, and waiting time between making an appointment and the actual visit.

Case management and care coordination services of the MC plan probably underlie its better care access ratings, note the researchers. For example, each special needs child enrolled in the MC plan was assigned a case manager, who was responsible for scheduling appointments, arranging transportation, and facilitating the services each child received from primary care doctors, specialty providers, and the public school system. Also, the MC plan reimbursed pediatricians and physician specialists at twice the rate of those paid to physicians under FFS. However, most of the children in the study were black and from urban areas, so the findings may not generalize to other races or to children in rural areas.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10912).

See "Caregivers' ratings of access: Do children with special health care needs fare better under fee-for-service or partially capitated managed care," by Drs. Mitchell and Gaskin, in the February 2007 Medical Care 45(2), pp. 146-153.

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