Success Spurs Growth of Medicaid Managed Care for Children with Special Health Care Needs

Two decades ago, the majority of state Medicaid programs that served children and youth with special health care needs (CYSHCN) relied on a traditional, fee-for-service model to pay for the complex mix of health care services that this group of children often need. But as states became more adept at designing new health care delivery programs, they have begun enrolling Medicaid beneficiaries with chronic and complex medical needs into Medicaid managed care (MMC) programs.

Some states are discovering that MMC can provide greater opportunities for coordinating care, controlling costs, and improving health care quality and outcomes for CYSHCN.

To implement these programs, state Medicaid agencies are contracting with managed care organizations (MCOs) to provide care and support services for a set price (per member, per month) with the goal of providing high-quality care at lower costs. These state programs are unique, with each state creatively designing plans to serve specific CYSHCN populations. Knowing what plans and policies states have adopted, outlined in a 50-state scan, provides important insights into national trends and new approaches that states can use to transform their MMC models to serve CYSHCN.

A recent NASHP nationwide analysis found 47 states and Washington, DC, now use some form of managed care to serve all or some children and adults enrolled in Medicaid today. Of the states with managed care delivery systems, all enroll at least some or all of their CYSHCN into some type of Medicaid managed care. Most enrollment is in risk-based managed care, where the MCO assumes financial risk.

NASHP’s issue brief, and 50-state map and chart provide an easy-to-use reference guide to learn what individual states are doing as they redesign health care for their CYSHCN. NASHP’s analysis found that enrollment in MMC varies by state and subpopulation of CYSHCN:

  • 42 states enroll children in the Medicaid Aid to the Aged, Blind and Disabled (ABD) category of assistance in MMC;
  • 42 states enroll foster care youth in MMC;
  • 22 states enroll children who receive Supplemental Security Income (SSI) in MMC; and
  • 14 states enroll children in 1915(c) Medicaid waiver programs in MMC.

Most states with MMC enroll CYSHCN on a mandatory basis and serve CYSHCN in standard health plans that serve all Medicaid beneficiaries. A small number of states have developed specialized managed care plans for CYSHCN.

In addition to rapidly expanding MMC, states are also evaluating if this health care delivery model is truly improving the quality of care for Medicaid beneficiaries. Two-thirds of states (33) have incorporated quality measurement requirements specifically for CYSHCN into their managed care contracts to assess how well these systems are serving children’s needs. These and other findings about enrollment of CYSHCN in MMC are summarized in a new issue brief and a 50-State Chart and Map. NASHP has also taken an in-depth look at Medicaid managed care delivery systems for CYSHCN in six states, and state use of Medicaid quality metrics for CYSHCN. These and other resources will be released in the next two