State-Level Variation in Medicaid Managed Care Enrollment and Specialty Care for Publicly Insured Children

Abstract

ImportanceMedicaid and Children’s Health Insurance Program cover almost 50% of children with special health care needs (CSHCN). CSHCN often require specialty services and have been increasingly enrolled in Medicaid managed care (MMC) plans, but there is a dearth of recent national studies on specialty care access among publicly insured children and particularly CSHCN.ObjectiveTo provide recent, nationwide evidence on the association of MMC penetration with specialty care access among publicly insured children, with a special focus on CSHCN.Design, Setting, and ParticipantsThis cross-sectional study used nationally representative data from the 2016 to 2019 National Survey of Children’s Health to identify publicly insured children in 41 states that administered comprehensive managed care organizations for Medicaid. Data analysis was performed from May 2022 to March 2023.ExposureForm CMS-416 data were used to measure state-year level share of Medicaid-enrolled children who were covered by MMC (ie, MMC penetration).Main Outcomes and MeasuresMeasures of specialty care access included whether, in the past year, the child had (1) any visit to non–mental health (MH) specialists, (2) any visit to MH professionals, and (3) any unmet health care needs and (4) whether the caregiver ever felt frustrated getting services for their child. Logistic regression models were used to examine the association of MMC penetration with specialty care access among all publicly insured children, and separately for CSHCN and non-CSHCN.ResultsAmong 20 029 publicly insured children, 7164 (35.8%) were CSHCN, 9537 (48.2%) were female, 4110 (37.2%) were caregiver-reported Hispanic, and 2812 (21.4%) were caregiver-reported non-Hispanic Black (all percentages are weighted). MMC was not associated with significant changes in any visit to non-MH specialists and unmet health care needs. In addition, MMC penetration was positively associated with caregiver frustration among all children (adjusted odds ratio, 1.23; 95% CI, 1.03-1.48; P = .02) and was negatively associated with any visit to MH professionals among CSHCN (adjusted odds ratio, 0.75; 95% CI, 0.58-0.98; P = .04).Conclusions and RelevanceIn this cross-sectional study evaluating MMC and specialty care access for publicly insured children, increased MMC enrollment was not associated with improved specialty care access for publicly insured children, including CSHCN. MMC was associated with less access to specialties like MH and increased frustrations among caregivers seeking services for their children.

Health Insurance Type and Outpatient Specialist Care Among Children With Asthma

“…Differences in asthma specialist care use could contribute to this disparity; however, little is known about use of specialists by children, particularly with respect to comparisons by insurance type or changes over time . Pediatric specialists are less likely to accept patients with Medicaid than patients with private insurance, which may limit access to specialty care . Most studies of specialist use in pediatric asthma have been limited to specific organizations or settings (eg, ED), and include relatively small or nongeneralizable samples.…”

“… 11 Pediatric specialists are less likely to accept patients with Medicaid than patients with private insurance, 12 , 13 , 14 which may limit access to specialty care. 15 , 16 Most studies of specialist use in pediatric asthma have been limited to specific organizations or settings (eg, ED), and include relatively small or nongeneralizable samples. In these studies, asthma specialists are generally underutilized in relation to guideline recommendations.…”