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Impact of the Oregon Health Plan on children with special health care needs
J B Mitchell1, G Khatutsky, N L Swigonski
1Health Economics Research, Inc, Waltham, Massachusetts 02452, USA. jmitchell@her-cher.org
Insights
Children with disabilities in Medicaid managed care had similar access to specialty care as those without special needs. However, children with asthma faced greater unmet needs, highlighting a gap in care access for non-SSI eligible children.
Area of Science:
- Health Services Research
- Pediatric Health Policy
- Managed Care Systems
Background:
- Medicaid managed care enrollment is rising for children, yet understanding outcomes for those with special health care needs remains limited.
- Access to specialty services and system navigation are key concerns for children with special health care needs in managed care.
- The Oregon Health Plan provides a case study for examining these experiences.
Purpose of the Study:
- To compare the managed care experiences of children with and without special health care needs within the Oregon Health Plan.
- To assess access to specialty care and overall satisfaction for different pediatric groups under managed care.
- To identify potential disparities in care for vulnerable child populations.
Main Methods:
- Telephone surveys were administered to parents of children enrolled in the Oregon Health Plan.
- Three distinct child groups were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs.
- Descriptive and multivariate analyses were employed to evaluate the impact of Medicaid managed care on access and satisfaction.
Main Results:
- Children with disabilities in managed care reported no greater difficulty accessing specialty care compared to children without special health care needs.
- Children with asthma experienced higher levels of unmet needs for services.
- No significant differences in access were observed between children with disabilities in managed care versus those remaining in fee-for-service arrangements.
Conclusions:
- Children with asthma, particularly those not eligible for SSI, encountered challenges in obtaining necessary services, unlike SSI-eligible children with disabilities.
- Lack of eligibility for specific consumer protections may contribute to service access difficulties for some children with special health care needs.
- States must establish robust identification and service assurance mechanisms to effectively enroll and support all children with special health care needs in managed care programs.
Objective:
Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan.
Methodology:
Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction.
Results:
Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service.
Conclusions:
Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.
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