Related Experiment Videos
Changes in continuity of enrollment among high-risk children following implementation of TennCare
W O Cooper1, G B Hickson, C L Gray
1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn 37232-8555, USA. william.cooper@mcmail.vanderbilt.edu
Insights
TennCare, Tennessee's Medicaid program, improved healthcare enrollment continuity for infants and chronically ill children. This study shows reduced gaps in coverage for these vulnerable populations after program implementation.
Area of Science:
- Health Services Research
- Public Health Policy
- Pediatric Health
Background:
- TennCare, Tennessee's Medicaid managed care program, was established in 1994.
- Key goals included controlling healthcare spending and enhancing access to care.
Purpose of the Study:
- To evaluate changes in enrollment continuity after TennCare implementation.
- Focused on two groups: infants (0-12 months) and chronically ill children (0-18 years).
Main Methods:
- Retrospective cohort analysis.
- Examined infants born in 1992/1995 and hospitalized children with chronic conditions in 1992/1995.
- Defined continuity by enrollment gaps of 7+ days in the first year for infants and 1 year post-discharge for children.
Main Results:
- Reduced proportion of infants lacking continuous first-year enrollment post-TennCare (19.4% vs. 25.1%).
- Decreased proportion of hospitalized children with chronic conditions experiencing enrollment gaps (14.3% vs. 23.3%).
- Improvements occurred despite increased initial enrollment delays for some infants.
Conclusions:
- TennCare implementation enhanced healthcare coverage continuity.
- Benefits observed for both infants and chronically ill children in Tennessee.
Background:
TennCare, Tennessee's Medicaid managed care program, was introduced in 1994 with the goals of controlling spending and of improving access to health care.
Objective:
To assess changes in the continuity of enrollment following the implementation of TennCare for 2 groups: infants in the first year of life (defined as persons aged 0-12 months in this study) and children hospitalized with a chronic health condition (defined as persons aged 0-18 years in this study).
Design:
Retrospective cohort analysis.
Setting And Population:
Infants born during 1992 or 1995 to women enrolled in Medicaid or TennCare and 0- to 18-year-old children enrolled in Medicaid or TennCare who were discharged from a hospital during 1992 or 1995 with a chronic health condition.
Main Outcome Measures:
For infants, failure to enroll an infant in the first 30 days of life or subsequent gaps in enrollment for 7 days or longer during the first year of life. For children hospitalized with a chronic health condition, any gap in enrollment lasting 7 days or longer by 1 year after discharge from a hospital.
Results:
There was a reduction in the proportion of infants without continuous enrollment in the first year of life following TennCare (19.4% after vs 25.1% before TennCare; odds ratio, 0.69; 95% confidence interval, 0.67-0.72). Improvements in continuity of enrollment for infants occurred despite an increase in the proportion of infants who were not enrolled in TennCare in the first 30 days of life, even though their mother was enrolled at delivery (14.0% after vs 8.0% before TennCare; odds ratio, 1.86; 95% confidence interval, 1.78-1.96). There was a decrease in the proportion of children hospitalized with a chronic health condition who had subsequent gaps in enrollment by 1 year following discharge from a hospital (14.3% after vs 23.3% before TennCare; odds ratio, 0.52; 95% confidence interval, 0.46-0.59).
Conclusion:
For infants in the first year of life and for children hospitalized with a chronic health condition, implementation of TennCare improved continuity of coverage.