Proportion of children in Medicaid managed care plans increases from 65% to 94%

Ann & Robert H. Lurie Children's Hospital of ChicagoMar 1 2021

Nationally, the number of children under age 21 enrolled in Medicaid grew from 23.5 million in 2000 to 40.5 million in 2017, with the proportion of children in Medicaid managed care plans increasing from 65 percent to 94 percent, according to a study from Ann & Robert H. Lurie Children's Hospital of Chicago published in the journal Academic Pediatrics.​

A key principle of managed care is access to routine preventive care services. While managed care has become the predominant form of Medicaid coverage for youth, researchers found only a modest increase in the receipt of preventive care services in this population, with marked variation across states. Whereas some states experienced improvements in preventive care services delivery for children as they implemented managed care, others did not.

State-specific differences in the association of managed care Medicaid with preventive care for youth may include access to primary care, Medicaid reimbursement, availability of clinicians in managed care networks, and state oversight of the quality of care of Medicaid managed care organizations. Managed care by itself is not enough to improve care for children who are covered by Medicaid. States must consider multiple factors that influence access to care and delivery of care at the community and clinic level within managed care systems."

Jennifer Kusma, MD, Study Lead Author and Physician, Lurie Children's Hospital, Instructor, Pediatrics, Feinberg School of Medicine, Northwestern University

Dr. Kusma and colleagues used annual state-level data from the Centers of Medicare and Medicaid Services (CMS) to assess the relationship between Medicaid managed care and preventive care encounters for youth. Such services include immunizations, growth and development evaluation, anxiety and depression screening, lead level monitoring and oral health surveillance.

CMS has set a yearly goal of 80 percent participation in the Early and Periodic Screening, Diagnostic, and Treatment benefit, meaning that 80 percent of children enrolled in Medicaid should receive at least one visit or screen in a year.

The frequency of preventive care expectations is based on recommendations from the American Academy of Pediatrics and US Preventive Services Task Force. Routine screenings are particularly important in promptly detecting developmental delays, such as autism spectrum disorder, when early intervention is known to be beneficial.

Regular screenings are also important for adolescent health and well-being, as many engage in higher risk behaviors and up to 20 percent have undiagnosed behavioral health disorders that can be detected during regular check-ups in primary care.

"We found that older children had lower rates of preventive care than younger children," says Dr. Kusma. "This pattern has been reported in other research, and it reveals an opportunity for managed care plans to help improve quality of care by encouraging preventive care visits for adolescents as well as for younger children."