Dataset Information

Identifying Children with Special Health Care Needs Using Medicaid Data in New York State Medicaid Managed Care.

ABSTRACT:

Objective

The ability to identify children with special health care needs (CSHCN) is crucial to evaluate disparities in the quality of health care for children in Medicaid Managed Care. We developed and assessed the accuracy of a new method to classify CSHCN.

Data sources

Secondary data analysis was conducted using NYS Medicaid administrative data and the Children with Chronic Conditions Screener (CCC Screener).

Study design

This study included 5,907 NYS Medicaid beneficiaries (17 years old or younger) whose parents completed the CCC Screener in 2014. Medicaid administrative data were used to create a risk score to assess the risk of special needs, and a cut point was identified to differentiate between children with versus without special needs. Diagnostic accuracy of the method was assessed using sensitivity and specificity analyses.

Principal findings

Applying the CCC Screener as the "gold standard," the risk score correctly classified the majority of CSHCN as positive (sensitivity = 75 percent) and the majority of the children without special needs as negative (specificity = 79 percent). This method demonstrated decent diagnostic ability (AUC = 0.77).

Conclusions

Our method can identify CSHCN in the NYS Medicaid Managed Care population and will help the State monitor the quality of care for this vulnerable population.

SUBMITTER: Miller LS

PROVIDER: S-EPMC6232435 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Identifying Children with Special Health Care Needs Using Medicaid Data in New York State Medicaid Managed Care.

Miller Lauren S LS Miller Lauren S LS Wu Meng M Schettine Anne M AM Cogan Lindsay W LW

Health services research 20180921 6

<h4>Objective</h4>The ability to identify children with special health care needs (CSHCN) is crucial to evaluate disparities in the quality of health care for children in Medicaid Managed Care. We developed and assessed the accuracy of a new method to classify CSHCN.<h4>Data sources</h4>Secondary data analysis was conducted using NYS Medicaid administrative data and the Children with Chronic Conditions Screener (CCC Screener).<h4>Study design</h4>This study included 5,907 NYS Medicaid beneficiar ...[more]

PMID: 30238977

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Project description:ImportanceMedicaid 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.ObjectiveTo 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 participantsThis 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.ExposureForm CMS-416 data were used to measure state-year level share of Medicaid-enrolled children who were covered by MMC (ie, MMC penetration).Main outcomes and measuresMeasures 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.ResultsAmong 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).Conclusions and relevanceIn 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.

Project description:ImportanceChildren with special health care needs (CSHCN) are recognized to be at increased risk of developing dental caries (decay). Evidence is mixed regarding the association of preventive oral health care delivered by pediatric primary care clinicians with caries experience among CSHCN.ObjectiveTo investigate caries experience, including untreated decay, among Medicaid-enrolled preschoolers with or without special health care needs.Design, setting, and participantsThis cross-sectional study used baseline data from the Pediatric Providers Against Cavities in Children's Teeth study, a cluster-randomized hybrid effectiveness-implementation trial conducted among 1022 Medicaid-enrolled preschoolers aged 3 to 6 years attending well-child visits at 18 participating community pediatric primary care practices in northeast Ohio. Baseline data were collected from November 1, 2017, to August 31, 2019, with statistical analyses conducted from April to August 2022.ExposuresPresence of special health care needs, as assessed by applying the Pediatric Medical Complexity Algorithm to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, was abstracted from electronic medical records. CSHCN were defined as having either noncomplex chronic disease (presence of only 1 nonprogressive chronic condition, or multiple nonprogressive chronic conditions in a single body system) or complex chronic disease (presence of any progressive chronic condition, malignant neoplasm, or significant chronic conditions involving multiple body systems).Main outcomes and measuresUntreated dental decay and caries experience as assessed through clinical dental examinations using International Caries Detection and Assessment System criteria.ResultsA total of 1022 children aged 3 to 6 years from 18 practices were enrolled in the study. The mean (SD) age of the study population was 4.3 (1.1) years, 554 (54.2%) were boys, and of 988 with data on race and ethnicity, 451 (45.6%) were Black. Of these, 301 of 1019 (29.5%) had a likely special health care need (225 with noncomplex chronic conditions and 76 with complex chronic conditions). The most frequent chronic conditions included asthma (n = 209) and mental or behavioral health disorders (n = 146), including attention-deficit/hyperactivity disorder, autism, and developmental delays. Overall, 296 children (29.0%) had untreated decay, and 378 (37.0%) had caries experience (decayed and filled teeth). Accounting for sociodemographic characteristics, CSHCN had 34% reduced odds of untreated decay (adjusted odds ratio [AOR], 0.66 [95% CI, 0.48-0.92]) compared with those with without chronic disease. In addition, caries experience was lower among CSHCN (AOR, 0.79 [95% CI, 0.60-1.04]).Conclusions and relevanceIn this cross-sectional study of Medicaid-enrolled children who attended well-child visits as preschoolers, untreated dental decay was lower among CSHCN compared with those without chronic conditions. This study suggests that CSHCN may have had better access to the various types of dental care facilitated in medical settings.

Project description:ObjectiveTo evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma.Data sourcesMedicaid managed care administrative claims data from 2013 to 2016, obtained from a southeastern state.Study designA difference-in-difference analysis compared patients' outpatient, inpatient, and emergency department (ED) utilization and receipt of recommended services before and after implementation of a statewide redistribution of patients among nine managed care plans.Data collection/extraction methodsEnrollment data for children with asthma were linked to the administrative claims. Children were included if they had a diagnosis of persistent asthma in 2013 and if they were enrolled continuously throughout 2014-2016.Principal findingsAmong the 28 537 children with asthma, 26% were forced to switch their managed care plan after the redistribution. Of these, 67% also switched their primary care provider (PCP). Relative to those who remained in their plan, disruption was associated with an additional 2.1 percentage-point decrease in the number of children who had an outpatient visit per quarter [95%CI -2.8, -1.3], from 71% to 66% (compared to plan stayers: 74% to 71%). Among children experiencing a change to their plan, there was overall a decrease in the proportion of children receiving an asthma-specific visit per quarter, but there was less of a decrease in children that also changed their PCP [1.6 percentage points, 95%CI 0.7, 2.5], from 9.7% to 8.3% (compared to those who did not switch their PCP: 12% to 8.6%). Indicators of asthma care quality and emergent care utilization were not significantly different between the two periods.ConclusionsWhile there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.

Dataset Information

Identifying Children with Special Health Care Needs Using Medicaid Data in New York State Medicaid Managed Care.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Identifying Children with Special Health Care Needs Using Medicaid Data in New York State Medicaid Managed Care.

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