Medicaid Managed Care Structures and Care Coordination.

Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P < .001). Fee-for-service served as the referent. State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs.

Gilchrist-Scott DH ，Feinstein JA ，Agrawal R 《-》

Effects of Medicaid managed care programs on health services access and use.

Garrett B ，Davidoff AJ ，Yemane A 《HEALTH SERVICES RESEARCH》

Has Medicaid managed care affected beneficiary access and use?

Zuckerman S ，Brennan N ，Yemane A 《INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING》

Medicaid managed care and health care for children.

Baker LC ，Afendulis C 《HEALTH SERVICES RESEARCH》

Impact of a decline in Colorado Medicaid managed care enrollment on access and quality of preventive primary care services.

Berman S ，Armon C ，Todd J 《-》