Sue E. Kim, PhD Paul W. Newacheck, DrPH University of California, San Francisco

1. Access and Satisfaction with Care for Children with Special Health Care Needs in Medicaid Managed Care Plans Sue E. Kim, PhD Paul W. Newacheck, DrPH University of California, San Francisco

2. Background • Children with Special Health Care Needs (CSHCN) are children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition. • About 16% (11 million) of children are identified as having special health care needs.

3. Background • Use more health care services than other children. • Have higher health care expenditures. • Few studies have examined access and satisfaction using a nationally representative sample.

4. Objective • To examine whether access and satisfaction differed for Medicaid enrolled CSHCN in managed care organizations versus those not in managed care.

5. Methods • Design: Cross-sectional study • Subjects: Children <18 years old with special health care needs • Dataset: 2000 and 2001 Medical Expenditure Panel Survey (MEPS)

6. Medicaid Managed Care Plans • Identified plans from a list of state names or programs for Medicaid HMOs in the area. • Medicaid Gatekeeper plans. • Medicaid non-MCO • Covered by Medicaid, but the plan was not an HMO or gatekeeper plan.

7. Primary Outcome Variables • CAHPS and other Access Measures • Access to care • Problems receiving needed care • Experiences during care • Problems in getting a referral to a specialist • Usual source of health care

8. Analysis • Pearson chi-squared statistics to compare difference between CSHCN enrolled in Medicaid managed care plans and non- managed Medicaid plans. • 2000 and 2001 MEPS data pooled • Corrected for complex survey design

9. Study Population • Sample size=808 • 13, 717 children <18 years old • 2,205 (16%) with special health care needs • 808 (37%) in Medicaid • 511 (63%) Medicaid HMO/managed care • 297 (37%) non-managed Medicaid plan

10. Results • Access to Care: No significant difference • Have usual source of health care • Able to make routine appointment when needed • Received illness or injury care when wanted • Had no problem receiving necessary care

11. Child’s doctors explains things in a way parents can understand Results P=.03

12. Child’s doctors spend enough time with child and parent Results P=.05

13. Satisfied with Usual Source of Health Care Staff Results P=.05

14. Satisfied with Quality of Care Results P=.05

15. Problems in getting referral to specialist Results P<.01

16. Conclusions • No significant difference in health care access for CSHCN enrolled in managed care and non-managed Medicaid plans. • Majority of respondents • had usual source of health care • able to receive routine care • had no problem receiving necessary care

17. Conclusions • CSHCN enrolled in managed care Medicaid plan showed lower satisfaction with their physicians. • Spending enough time with child and parent • Satisfaction with usual source of care staff • Satisfaction with quality of care

18. Conclusions • Referral to Specialist • Medicaid managed care plan enrollees are two times more likely to have problem getting referral to specialist compared to non-managed care plans.

19. Limitations • MEPS estimates of the number of persons in HMOs are higher than industry figures. • Managed care questions asked about the last plan held by respondent. • Preliminary results and only descriptive.

20. Implications • Important to consider whether lower satisfaction with providers in managed care plans and greater difficulty in accessing specialists are associated with lower quality of clinical care.