The 130th Annual Meeting of APHA

Abstract #47145

Darrell Gaskin, PhD, Research Associate Professor, Georgetown University, 2233 Wisconsin Avenue, NW, Suite 525, Washington, DC 20007, (202) 687-0880, dgaskin@jhsph.edu and Jean Mitchell, PhD, Graduate Public Policy Institute, Georgetown University, 3600 N Street 2nd Floor, Washington, DC 20007.

We will evaluate the effect of Medicaid managed care on the use of services for children with special health care needs (SHCN). We will analyze Medicaid enrollment, claims and encounter data for children with SHCN (as determined by eligibility for Supplemental Security Income (SSI)) who enrolled in the DC Medicaid program. Currently, parents of children with SHCN who quality for SSI can enroll their child in Health Services for Children with Special Needs (HSCSN), a capitated managed care plan or remain in regular fee-for-service (FFS) Medicaid. We will compare use of services for children with SHCN enrolled in FFS Medicaid to those enrolled in HSCSN. Our study aims are: 1) to analyze factors determining the decision to enroll in HSCSN versus FFS and 2) to evaluate the effect of enrollment in HSCSN, child health status, and other characteristics on use of services.

The primary data source for these analyses is Medicaid eligibility and claims data available from the DC Medicaid program. Examples of service use to be examined include child encounters for appropriate preventive care (compliance with recommended well-child visits and immunizations), preventive dental visits, screening for lead blood levels and sickle cell anemia, use of antibiotic prescriptions without a corresponding physician visit, referrals to specialists, use of specialty services, use of prescribed medications for specific health conditions, emergency room use, hospitalizations for ambulatory sensitive conditions, and continuity of care, and whether the child is receiving appropriate medications for specific chronic conditions.

We recognize that endogeneity of plan choice is likely to bias comparisons of children who enroll in FFS and those in HSCSN. To address this issue we estimate a treatment effects model. The model assumes that the decision to enroll in HSCSN or FFS is a function of individual, neighborhood characteristics, family characteristics, child characteristics (e.g., health status). The utilization of services by each child is a function of individual characteristics and plan choice. The residuals in both equations are assumed to follow a bivariate normal distribution. The plan choice equation is estimated with a probit model. While the indicators of utilization in the model described above are continuous, the treatment effects model can be easily modified to accommodate indicators of utilization which are either dichotomous or a discrete count of services. The neighborhood characteristics (i.e., percentage of eligible households in the census tract who are enrolled in the plan, provider density) are used to identify the plan choice equation.

Learning Objectives: Participants will learn about

• Medicaid managed care programs for children with special health care needs, and
• health service use of children with special health care needs who are covered by Medicaid.

Keywords: Medicaid Managed Care, Children With Special Needs

Presenting author's disclosure statement:
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.