314 - Family-Reported Impacts of Medicaid Managed Care Health Insurance Coverage on Receipt of Care for Children with Medical and Social Complexity

Publication Number: 314.4774

Jennifer Saper, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Emily Golbeck, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Matthew M. Davis, Nemours Children's Hospital, Wilmington, DE, United States; Carolyn C.. Foster, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Policy experts have suggested that enrollment of children and youth with special health care needs (CYSHCN), including complex social needs, in Medicaid managed care (MMC) plans may cause care delays due to changes in provider networks and formularies. More research is needed to understand the impact of MMC specifically on medically and socially complex children, who are susceptible to inequities in health care access. In 2020, the State of Illinois transferred children from "select populations" of CYSHCN from fee-for-service (FFS) Medicaid to MMC, providing an opportunity to evaluate the impact of MMC on these groups.

Objective: To understand parent perspectives of their children’s access to care after the transition from FFS to MMC.

Design/Methods: Using our institution’s electronic medical record, we sampled parents of CYSHCN 0-17 years who were enrolled in Medicaid through 1 of 3 select populations required to transition to MMC and parents of CYSHCN already enrolled in MMC (controls). Electronic surveys were sent in wave 1 (“pre-transition” April 2020) asking about care access November 2019-February 2020. Wave 2 surveys (“post-transition” April 2021) asked about care access after the transition. Both surveys assessed barriers to accessing medications, therapies, and needed subspecialty services. Respondents who completed both survey waves were included in this analysis. Logistic regression was performed comparing the select population post-transition to controls.

Results: In the study sample (n=319; select subgroups n=124; controls n=195), mean child age was 8.1 years. On a scale from 1-10, the proportion reporting their health plan 9 or 10 (“top- box” score) was lower pre- than post-transition for the select populations versus controls (Table 1). The select populations improved their top-box proportion to 46.0% (+10.2 points; p<.05). The control group improved their top-box proportion to 62.7% (+7.5 points; p<.01). Comparing patients who transitioned to MMC versus controls, there were higher odds for special populations post-transition of specialists not having appointments (OR 1.75), needing a prior authorization (OR 1.94), and equipment delays (OR 5.12) (Table 2).

Conclusion(s): We found an increase in rating their health plan a 9 or a 10, among the select population that transitioned to MMC, and the controls. In a few instances, challenges were exacerbated by the transition. Evaluating the transition for CYSHCN in other states and with other special populations may help identify clinically meaningful policy implications, including additional transition support for needed medications and devices.

Table 1. Parent ratings of children’s health insurance plan of a 9 or 10, before and after transition to Medicaid Managed Care.a
a. “Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your child’s health plan from November 1, 2019 (January 31, 2020) to January 31, 2020 (January 31, 2021)?”
b. Social Security Income; c. Division of Specialized Care for Children, d. Department of Children and Family Services

Table 2. Odds ratio of parents reporting barriers to different aspects of care for children in Medicaid Managed Care compared post-transition to controls.