This paper reports on deviations from accepted standards of care for vulnerable populations of Medicaid Managed Care children and HIV patients in Connecticut. The study identifies accepted treatments, assesses coverage by managed care plans, and evaluates patient outcomes resultant from health plan decisions. Outcomes due to plan coverage of perinatal and mental health services for children will be examined using medical records and satisfaction surveys. Outcomes for HIV-related protease inhibitor complications, specifically lipodystrophy and peripheral neuropathy, will also be measured using viral load and CD4+ cell counts.
As managed care has evolved, Medicaid has transferred patients to HMO plans in Connecticut, raising concerns of mistreatment in an already vulnerable population. Children have been disenfranchised and HIV patients have been stigmatized by mainstream society and medicine. Because Medicaid recipients are generally socially disadvantaged, they are not likely to challenge coverage limitations, allowing plans to eschew compliance with national standards. Coverage decisions, therefore, are a resource allocation issue that affects quality of care for patients. While lack of coverage for certain treatments may be due to ignorance rather than reasoned decisions, patient health outcomes may be adversely affected.
This study compares the five most common Medicaid Managed Care plans in Derby and New Haven, Connecticut to accepted standards of care. The study examines patient outcomes resultant from gaps in HMO treatment packages, utilizing both patient charts from area health centers and surveys. The purpose is to identify and propose recommendations for gaps that lead to adverse health outcomes for vulnerable populations.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: 1. Identify standards of care for children as related to mental health and maternal-perinatal health. 2. Identify standards of care for HIV patients as related complications arising from use of protease inhibitors, especially for treatment of lipodystrophy and peripheral neuropathy. 3. Articulate weaknesses in Medicaid Managed Care coverage of HIV patients and children
Keywords: Medicaid Managed Care, HIV/AIDS
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Connecticut managed care organizations.
Connecticut Community Health Centers, Derby and New Haven, Connecticut
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.