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Clinical need for disenrollment from mandatory Medicaid managed care in a population of homeless families

Roy Grant1, Douglas Berman1, Mindy Lieberman2, Lourdes Lynch, PhD3, and Michael Lambert, MBA2. (1) The Children's Health Fund, 317 East 64th Street, New York, NY 10021, 212-535-9400, rgrant@chfund.org, (2) New York Children's Health Project, Children's Hospital at Montefiore, 317 East 64thStreet, New York, NY 10021, (3) Division of Community Pediatrics, Children's Hospital at Montefiore, 317 East 64th Street, New York, NY 10021

During 2003, the New York Children’s Health Project disenrolled 689 homeless family members from mandatory Medicaid managed care, consistent with their “exempt” status per New York State regulations. Within this group 55% (379) were established patients of the Project. We performed a retrospective electronic patient record review of a random sample of 100 of these disenrolled patients (65% pediatric, 35% adult, consistent with the overall patient population). These 100 patients had a total of 480 primary care visits through 12/31/03 (mean, one per patient per month) and 80 behavioral health visits. Twenty-three percent of the children were treated for otitis media; 20% had asthma; and 14% had diagnosed developmental or behavioral problems. Twenty-nine percent of adults had asthma; 17% were obese (BMI > 30); and 51% were diagnosed with a mental health condition (principally depression or PTSD). Overall, 32% of the children and 46% of the adults had a chronic health condition; 40% of the children and 80% of the adults required at least one specialist referral for conditions including seizure disorder, lymphedema, hypertension, numbness, injury, hallucinations, precocious puberty, esotropia, and hearing loss. Preventive services included immunization, PPD, and perceptual-developmental screening; and for adults PAP smears (one abnormal) and prenatal care. Because these families were placed in shelters distant from their former communities and health networks, we conclude that access to care would have been compromised by continued managed care enrollment. We further question their prior utilization and access to care, given the nature and seriousness of health conditions treated.

Learning Objectives:

Keywords: Homeless Health Care, Access to Health Care

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.

Interventions, Evaluations and Research Issues and Findings Among Homeless Populations

The 132nd Annual Meeting (November 6-10, 2004) of APHA