THE FAMILY PARTNERS PROJECT:
The Health Care Experiences of Families of Children with Special Health Care Needs

THE EFFECT OF THE CHILD’S MEDICAID ENROLLMENT UPON PARENTAL RANKINGS OF HEALTH PLAN PERFORMANCE AND USE OF SERVICES
A Fact Sheet on Findings
What is the impact of having primary Medicaid coverage on children with special needs? When compared to children enrolled in privately purchased health plans, how well do children with Medicaid coverage fare with respect to parental rankings of the main health plan and use of needed services? 

Methods: Respondents indicated the payer of their child’s primary health plan—either Medicaid or privately purchased through their employer or by the family. Parents also responded to questions about their child’s use of
health care services. They also ranked the performance of their child’s main or primary health plan in relation to key coverage, service and informational domains.

Measures: First, plan performance was measured on twelve items covering such areas as providing benefits which meet the child’s needs, charging reasonable out-of-pocket costs, approving needed care, making available skilled and experienced primary, specialty and ancillary providers, ease of paperwork, provision of clear information. For each item, the respondent indicated the plan was excellent, good, okay or poor. 

Second, an index of cost containment was created based on four plan features (requirement in the plan for a primary care physician, requirement that prior referral be made by the primary care physician for specialty care, provider network in effect within the main health plan, and a limitation on the plan’s coverage of services outside a provider network). "Tightly managed" plans were those with most or all of these features, "medium managed" plans had some of these features, and "loosely managed" plans had few or none of these features.

Third, information was collected with respect to use of specific health services: use of primary and specialty doctors; mental health services; physical, occupational and speech therapy; home health services; hospitalizations; prescription medications; disposable medical supplies and durable medical equipment, etc. 

Findings:

• Over a third (39%) of the respondents reported that their child’s primary health plan was paid for by Medicaid. Approximately one third (34%) reported that their child a secondary health plan, most commonly paid by Medicaid or another public program.
  

• Among the respondents whose child’s main health plan was paid by Medicaid and who could identify the type of plan in which the child was enrolled, the vast majority (93%) indicated the plan was a managed care plan. Most (86%) said it was a HMO (health maintenance organization). Less than one in ten (7%) reported it to be a fee-for-service Medicaid plan. 
  

• Among children covered by Medicaid, almost two-thirds (62% ) were in plans classified as tightly managed, a quarter (26%) were in medium-managed plans and 12% were in loosely managed plans.
  

• Parents of children with primary Medicaid coverage in our sample differed significantly from parents without such coverage for their children, having lower pre-tax incomes (approximately $17,700 for the Medicaid group vs. $46,000 for the non-Medicaid group). They were also more likely to be single, less likely to be employed, had fewer years of education, and were more likely themselves to be in poorer health. 
  

• The children with primary Medicaid coverage differed from their non-Medicaid covered counterparts, with a higher percentage being from a racial minority (47% minority among those with Medicaid compared to 16% for the non-Medicaid group), were described as having more severe health conditions, and were described by their parents as being in poorer overall health. 
  

• Primary Medicaid coverage was associated with a higher incidence in the receipt of home health services, nutritional counseling services and special dietary products, even after controlling for having secondary coverage, parental demographics (income, education, health, employment and marital status), child health variables (overall health, stability of health conditions, and severity of condition) as well as the child’s race. 
  

• No differences were found between the Medicaid and non-Medicaid groups with respect to the incidence of receipt of the following: care from specialty doctors; physical, occupational or speech therapy; mental health services; durable medical equipment or disposable medical supplies; prescription medications; genetic counseling or testing, or respite services (controlling for having secondary coverage, parental demographics, child health variables, and child race). Similarly, primary Medicaid coverage was not associated with higher or lower utilization of primary doctors, emergency room visits or hospitalizations for mental health or medical treatment. 
  

• Parents of children with primary Medicaid coverage consistently ranked the performance of their main plan better than did parents of children without Medicaid coverage. On each of the twelve items of health plan performance, the rankings of respondents whose children had primary Medicaid were higher than their counterparts’ and for nine of these twelve items, the differences in rankings were statistically significant. 
  

• The finding of higher plan performance ratings among those whose child’s primary plan is paid by Medicaid (versus privately purchased) remains statistically significant even when accounting for the following variables: secondary coverage status, level of cost containment in the main plan, parental demographics (income, education, health, employment and marital status) child health variables (overall health, stability of health conditions, and severity of condition) and the child’s race.
  

• Among families whose child’s primary plan was paid by Medicaid, parental performance ratings were lowest among those whose child was enrolled in a "tightly managed" plan. Families of children in loosely managed plans had the highest performance ratings and those in medium managed plans ranked their child’s plan between the rankings of the other two groups. 
  

Additional information about the survey and its results can be obtained from: www.familyvoices.org

Nora Wells, Family Voices nwells@fcsn.org 1/888-835-5669

Marty Wyngaarden Krauss, Ph.D., Brandeis University krauss@brandeis.edu