Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Now with Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
JAMA Netw Open. 2023 Oct 2;6(10):e2336415. doi: 10.1001/jamanetworkopen.2023.36415.
Medicaid and Children's Health Insurance Program cover almost 50% of children with special health care needs (CSHCN). CSHCN often require specialty services and have been increasingly enrolled in Medicaid managed care (MMC) plans, but there is a dearth of recent national studies on specialty care access among publicly insured children and particularly CSHCN.
To provide recent, nationwide evidence on the association of MMC penetration with specialty care access among publicly insured children, with a special focus on CSHCN.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative data from the 2016 to 2019 National Survey of Children's Health to identify publicly insured children in 41 states that administered comprehensive managed care organizations for Medicaid. Data analysis was performed from May 2022 to March 2023.
Form CMS-416 data were used to measure state-year level share of Medicaid-enrolled children who were covered by MMC (ie, MMC penetration).
Measures of specialty care access included whether, in the past year, the child had (1) any visit to non-mental health (MH) specialists, (2) any visit to MH professionals, and (3) any unmet health care needs and (4) whether the caregiver ever felt frustrated getting services for their child. Logistic regression models were used to examine the association of MMC penetration with specialty care access among all publicly insured children, and separately for CSHCN and non-CSHCN.
Among 20 029 publicly insured children, 7164 (35.8%) were CSHCN, 9537 (48.2%) were female, 4110 (37.2%) were caregiver-reported Hispanic, and 2812 (21.4%) were caregiver-reported non-Hispanic Black (all percentages are weighted). MMC was not associated with significant changes in any visit to non-MH specialists and unmet health care needs. In addition, MMC penetration was positively associated with caregiver frustration among all children (adjusted odds ratio, 1.23; 95% CI, 1.03-1.48; P = .02) and was negatively associated with any visit to MH professionals among CSHCN (adjusted odds ratio, 0.75; 95% CI, 0.58-0.98; P = .04).
In this cross-sectional study evaluating MMC and specialty care access for publicly insured children, increased MMC enrollment was not associated with improved specialty care access for publicly insured children, including CSHCN. MMC was associated with less access to specialties like MH and increased frustrations among caregivers seeking services for their children.
医疗补助和儿童健康保险计划覆盖了近 50%有特殊医疗需求的儿童（CSHCN）。CSHCN 通常需要专业服务，并越来越多地加入医疗补助管理式医疗计划（MMC），但最近全国范围内关于公共保险儿童，尤其是 CSHCN 的专科护理获得情况的研究很少。
提供最近的全国性证据，说明 MMC 渗透率与公共保险儿童获得专科护理之间的关联，特别关注 CSHCN。
设计、地点和参与者：这项横断面研究使用了 2016 年至 2019 年全国儿童健康调查的全国代表性数据，确定了在管理全面管理式医疗组织的 41 个州中接受公共保险的儿童。数据分析于 2022 年 5 月至 2023 年 3 月进行。
使用 CMS-416 数据来衡量 Medicaid 参保儿童中接受 MMC 覆盖的州年度份额（即 MMC 渗透率）。
专科护理获得情况的衡量标准包括儿童在过去一年中是否（1）看过任何非心理健康（MH）专家，（2）看过任何心理健康专业人员，以及（3）是否有任何未满足的医疗保健需求，以及（4）看护人是否曾因为孩子获得服务而感到沮丧。使用逻辑回归模型来检验 MMC 渗透率与所有公共保险儿童、CSHCN 和非 CSHCN 的专科护理获得情况之间的关联。
在 20029 名接受公共保险的儿童中，7164 名（35.8%）是 CSHCN，9537 名（48.2%）是女性，4110 名（37.2%）是由看护人报告的西班牙裔，2812 名（21.4%）是由看护人报告的非西班牙裔黑人（所有百分比均为加权）。MMC 与任何非 MH 专家就诊和未满足的医疗保健需求均无显著变化相关。此外，MMC 渗透率与所有儿童的看护人沮丧感呈正相关（调整后的优势比，1.23；95%置信区间，1.03-1.48；P=0.02），与 CSHCN 中的任何 MH 专业人员就诊呈负相关（调整后的优势比，0.75；95%置信区间，0.58-0.98；P=0.04）。
在这项评估公共保险儿童 MMC 和专科护理获得情况的横断面研究中，MMC 参保人数的增加与公共保险儿童，包括 CSHCN 的专科护理获得情况的改善无关。MMC 与 MH 等专业服务的获得机会减少以及看护人在为孩子寻求服务时的挫败感增加有关。
