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Children with special health care needs seem to benefit from Medicaid managed care programs with case managers

To control escalating health care expenditures, a handful of State Medicaid programs have implemented a managed care option for children with special health care needs (CSHCN), which includes case management services or care coordination. A new study concludes that CSHCN with disabilities in such programs have better access to and receipt of occupational and physical therapy at school than those in Medicaid fee-for-service (FFS) plans.

Jean M. Mitchell, Ph.D., of Georgetown University, and colleagues evaluated use of speech, occupational, and physical therapy by CSHCN in the managed care or FFS plan of the District of Columbia Medicaid program that serviced only children (predominantly black) with disabilities.

Enrollment in the FFS rather than managed care plan reduced the likelihood that CSHCN received occupational therapy in school by 9.2 percentage points and physical therapy by nearly 11 percentage points. The marginal impact of plan type on speech therapy was not significant. Plan choice had no impact on the likelihood children would receive these services from the health care sector.

In addition, children in the FFS plan were 6 to 10 percentage points more likely to never receive speech, occupational, or physical therapy at school, and less likely to receive frequent occupational or physical therapy at school compared with managed care children. These differences are likely due to the availability of case management and care coordination that was an integral part of the partially capitated managed care plan, explain the researchers. For example, case managers typically coordinate the range of services reimbursed by Medicaid, including physicians, hospital, therapeutic services, transportation, dental, pharmaceutical, and mental health across multiple providers and sites. However, in FFS plans, caregivers of CSHCN must navigate the health care system on their own.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10912).

See "Partially capitated managed care versus FFS for special needs children," by Cynthia R. Schuster, M.P.P., Dr. Mitchell, and Darrell J. Gaskin, Ph.D., in the Summer 2007 Health Care Financing Review 28(4), pp. 109-123.

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