A study examined the impact of Medicaid-managed care enrollment on specialty care access for children, particularly those with special healthcare needs. Findings indicate that while enrollment didn’t worsen specialty care access, it was linked to increased caregiver frustration and reduced access to mental healthcare. This may be due to factors like limited provider availability and inaccurate directories. States can alleviate these issues by improving provider directories and offering special needs plans. Regardless of managed care enrollment, publicly insured children often face difficulties accessing specialty care, suggesting the need for broader healthcare system improvements.
A recent study explored the impact of Medicaid-managed care enrollment on access to specialty care for children. The findings suggest that while it didn’t lead to poorer access to specialty care for children with special healthcare needs, it was associated with increased frustration among caregivers and reduced access to mental healthcare.
Historically, children with special healthcare needs were exempt from Medicaid-managed care, but this changed in 2019 when 33 states mandated their enrollment. Medicaid-managed care typically involves private organizations assuming financial risk and receiving capitated payments from states. To control costs, these organizations often establish narrow provider networks and require prior authorization for specialty services, raising concerns about access to care for children with special healthcare needs who require specialized treatment.
The study analyzed data from the 2016 to 2019 National Survey of Children’s Health to investigate the link between Medicaid-managed care enrollment and specialty care access for publicly insured children. The researchers examined whether children had visited non-mental health specialists, or mental health professionals, or had unmet healthcare needs in the past year. They also assessed whether caregivers reported difficulties in accessing services for their children.
Among the 20,029 publicly insured children studied, 7,164 had special healthcare needs, while 12,865 did not. Children with special healthcare needs were more likely to visit non-mental health specialists (33% vs. 7.0%) and mental health professionals (36.1% vs. 4.0%) compared to those without special healthcare needs. However, they were also more likely to have unmet healthcare needs (10.3% vs. 2.4%) and for their caregivers to report frustration in accessing services (42.9% vs. 15.9%).
The analysis revealed no significant association between Medicaid-managed care enrollment and visits to non-mental health specialists, mental health professionals, or unmet healthcare needs. However, it did find a negative association with visits to mental health professionals and a positive association with caregiver frustration.
Overall, the study suggests that increasing Medicaid managed care enrollment may not significantly affect specialty care access for children with special healthcare needs, except for potentially increasing caregiver frustration. This frustration could be due to factors such as poor provider availability, inaccurate provider directories, and high physician turnover in Medicaid-managed care plans.
The decreased access to mental health professionals may be a result of the limited availability of specialty mental health practitioners in these plans. Additionally, some states may require children to use a separate behavioral health managed care plan for mental health services, which can create administrative burdens and barriers to care.
To address these challenges, states could improve provider directories and establish special needs plans for publicly insured children in Medicaid-managed care. It’s worth noting that publicly insured children often face difficulties in accessing specialty care regardless of their managed care enrollment, and states may consider increasing payment rates and streamlining administrative processes to encourage provider participation in fee-for-service Medicaid.