Managed Care

Monthly recertification of Medicaid eligibility may undermine delivery of quality health care for children

About one in five U.S. children is enrolled in a State Medicaid program. Children continuously enrolled in Medicaid throughout the year are much more likely to always or sometimes have an assigned primary care physician (PCP) and receive better care for middle ear infections (otitis media) than those who are discontinuously enrolled and lack a PCP.

Children who are continuously enrolled are far less likely to visit the emergency department (ED) for middle ear infections, more apt to fill antibiotic prescriptions for the condition, and more likely to be referred for needed ear surgery such as tube placement and/or adenoidectomy, according to a recent study. Findings from the study, which was supported by the Agency for Healthcare Quality and Research (HS07816), suggest that current monthly recertification of Medicaid eligibility leads to frequent shifts on and off the program, which may undermine delivery of cost-effective quality care.

Clearly, 12 months of continuous Medicaid enrollment and an assigned PCP improved the care of children with middle ear infections in the study by Stephen Berman, M.D., and colleagues at the University of Colorado Health Sciences Center. They analyzed the Medicaid Medical Events Database and Medicaid claims data to track otitis media-related diagnoses, antibiotics, outpatient visits, and surgeries for children enrolled in Colorado's Medicaid program from January 1 through December 31, 1991.

Continuously enrolled children were more than 4 times (odds ratio, 4.2 and 4.9) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the ED for an otitis media-related visit was increased by 26 percent and 50 percent, respectively, when a child sometimes or never had an assigned PCP compared with always having an assigned PCP. The likelihood of ever filling an antibiotic for the condition was reduced by 23 percent and 34 percent, respectively, when a child sometimes or never had an assigned PCP compared with always having one. Finally, surgical rates per 1,000 child-years for children age 13 to 18 months and 31 to 36 months were higher when they always had an assigned PCP compared with sometimes or never having one.

For more details, see "The influence of having an assigned Medicaid primary care physician on utilization of otitis media-related services," by Dr. Berman, Jessica Bondy, M.H.A., Dennis Lezotte, Ph.D., and others, in the November 1999 Pediatrics 104(5), pp. 1192-1197.

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