Medicaid Managed Care Structures and Care Coordination.

Area of Science:

• Health Services Research
• Pediatric Health Policy
• Managed Care Organization Analysis

Background:

• Child enrollment in Medicaid managed care (MMC) has significantly increased, largely driven by state mandates.
• Care coordination is a critical performance metric in MMC, influencing cost savings, health outcomes, and utilization.
• Understanding the impact of different MMC structures on care coordination for children is essential.

Purpose of the Study:

• To evaluate the association between enrollment in primary care case management (PCCM) and health maintenance organization (HMO) structures within MMC.
• To determine the relationship between these MMC structures and children's access to and receipt of care coordination.

Main Methods:

• Retrospective, cross-sectional analysis using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System.
• Examined relationships between fee-for-service, PCCM, or HMO enrollment and care coordination.
• Employed state-level univariate and multilevel multivariable analyses, controlling for demographic factors and state financing.

Main Results:

• Higher PCCM penetration rates were significantly associated with increased access (AOR: 1.23, P=.034) and receipt (AOR: 1.37, P=.02) of care coordination.
• Higher HMO penetration rates were significantly associated with decreased access (AOR: 0.85, P=.05) and receipt (AOR: 0.71, P<.001) of care coordination.
• Fee-for-service was used as the reference group for comparison.

Conclusions:

• Significant variation exists in state-level MMC utilization.
• Findings suggest that care coordination may be more effectively delivered through PCCM models compared to HMO models for children.
• Policymakers should prioritize care coordination outcomes when designing and structuring state Medicaid programs.