Medicaid is an important source of coverage and care for children with special health care needs (CSHCN). Little is known, however, about quality of care for CSHCN in Medicaid, especially children enrolled in a primary care case management (PCCM, or gatekeeper) model of managed care. Though much research is focusing on Medicaid HMOs, PCCM continues to be the dominant form of Medicaid managed care in many states. This study examines whether or not PCCM meets the needs of CSHCN, compared to children without special health care needs in Georgia's Medicaid and Children's Health Insurance Program, based on a survey of parents. Comparisons are made with publicly insured children in PCCM and HMO plans in other states. Several aspects of quality are measured, including geographic access to care, scheduling physician visits, parent/provider communication, and overall parent satisfaction. Multiple provider types are examined (e.g., primary and specialty care, dentistry, DME, therapy, mental health counseling, and transportation services). The survey instrument is the Consumer Assessment of Health Plan Study (CAHPS). Of the 3,220 publicly insured children surveyed, approximately a quarter have special health care needs. Initial chi-square and regression analyses indicate PCCM works better for healthy children than for CSHCN. Multi-state comparisons will be made when the National CAHPS Benchmarking data are provided to the authors in late February 2000. Taken together, the findings have implications for state policies regarding managed care for CSHCN.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Define primary care case management (PCCM) in state Medicaid and CHIP programs as a form of managed care. 2. Identify differences in quality of care for children with and without special needs in one state's PCCM program. 3. Compare the experiences of children with special needs enrolled in one state's PCCM program to national benchmarking data on PCCM and HMO managed care models. 4. Discuss implications for state policies regarding managed care for children with special needs
Keywords: Children With Special Needs, Quality of Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: The research grant for this study was provided by the Georgia Department of Community Health, which is responsible for the administration of the Medicaid and Children's Health Insurance Programs.
The 128th Annual Meeting of APHA