State Medicaid Managed Care Program Design for Children and Youth with Special Health Care Needs

State Medicaid agencies increasingly are providing services to children and youth with special health care needs (CYSHCN) through Medicaid managed care (MMC) delivery systems, including risk-based managed care, primary care case management (PCCM), and prepaid health plans. This table reviews key characteristics of states’ MMC program design for CYSHCN, including enrollment, whether states define CYSHCN in their managed care contracts, use of behavioral health services in MMC, and requirements for monitoring the quality of care provided to CYSHCN. The two maps illustrate the states that are enrolling CYSHCN in Medicaid managed care, by delivery system model (risk-based managed care, PCCM, or prepaid health plan), and the states that have specialized managed care plans for certain populations of CYSHCN. Additional findings are summarized in the accompanying issue brief, State Medicaid Managed Care Enrollment and Design for Children and Youth with Special Health Care Needs.

View the full 50-state table.

For an overview of the findings, read the companion blog, Success Spurs Growth of Medicaid Managed Care for Children and Youth with Special Health Care Needs.

More Information

Notes on the Sources used:
General background information on state Medicaid managed care programs was collected from:
• The Center for Medicare and Medicaid Services Spring 2016 Report on Medicaid Managed Care Enrollment and Program Characteristics, 2014. Read the report here.
• The Center for Medicare and Medicaid Services individual state managed care enrollment profiles, which can be found here.

Specific Information about state Medicaid managed care arrangements was collected and analyzed from state Medicaid managed care program websites and contracts between state Medicaid agencies and managed care organizations.

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number UC4MC28037 Alliance for Innovation on Maternal and Child Health: Expanding Access to Care for the Maternal and Child Health Population. The information or content and conclusions are those of NASHP and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US government.

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