MEDICAID MANAGED CARE AND TITLE V SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN, ALABAMA, OHIO, TENNESSEE).
Contributors: University of Alabama at Birmingham.
Published: 1996
Number of pages: 407
Subjects: Health Sciences, Nursing.; Health Sciences, Public Health.; Health Sciences, Health Care Management.
Description: Background. States are accelerating the rate at which they are moving chronically ill and disabled populations into managed care. Little is known about the extent to which managed care delivery systems are prepared to address the special needs of children with chronic illness and disabilities.

Methods. This study focused on Agencies for Children with Special Health Care Needs (CSHCN) in 3 states planning or implementing Medicaid managed care 1115 demonstration waivers: Alabama, Ohio, and Tennessee. A case study design was used to conduct interviews and collect data on how the needs of CSHCN were addressed in Medicaid managed care waivers, what role the Agency for CSHCN had in the development of state waivers, and how different payment mechanisms affect the process and outcomes of care for CSHCN.

Results. Services for CSHCN were part of the managed care arrangements in Alabama and Tennessee. Ohio carved-out services for the disabled. The decision to carve-out the study population was unrelated to the model of managed care or a history of collaboration between Medicaid and the Agencies for CSHCN. State waivers offered an enriched benefit package to enrollees. Services for CSHCN were gatekept and subject to determination of medical necessity. Quality assurance standards did not address the specific needs of these children. Fewer children were eligible for services from the Agency for CSHCN. Managed care plans controlled access to specialty care with pre-authorizations, limits on the number of visits, and closed provider panels. Plans used adult subspecialists for specialty care and disrupted long-standing provider relationships. Parents of CSHCN were frustrated about finding services for their children and were more dependent on care coordination from the Agency for CSHCN. Providers believed that managed care was not designed to meet the needs of the study population and that quality of care for these children would diminish. When the Agency for CSHCN was involved in planning the state waiver, consideration of special needs children was apparent in both design and contract requirements of the waiver.

Conclusions. These data suggest that the Agency for CSHCN should be involved in planning state waivers. States should develop oversight policies that include access and quality standards for CSHCN.
Notes: Source: Dissertation Abstracts International, Volume: 57-12, Section: B, page: 7448.

Thesis (D.S.N.)--UNIVERSITY OF ALABAMA AT BIRMINGHAM, 1996.

School code: 0005.