Medicaid Managed Care and Access to Specialty Care Restricted; Files Only

Abstract

Medicaid managed care (MMC) covers over 80% of Medicaid enrollees, many of whom have complex health care needs. While individuals with complex health care needs were historically exempted from MMC, they have been increasingly enrolled in MMC in recent years. Despite these recent enrollment trends and the high frequency of specialty care use among enrollees with complex health care needs, there have been no recent evaluations of the impact of MMC on access to specialty care for this population. This dissertation aims to provide contemporary evidence on the effects of MMC on access to specialty care among Medicaid enrollees with a special focus on enrollees with complex health care needs.

In Study 1, I evaluated whether states’ adoption of network adequacy standards for MMC plans was effective in improving access to specialty care for Medicaid-enrolled children, overall and among those with special health care needs. I found that while the adoption of network adequacy standards was not associated with significant changes in specialty care access among all Medicaid-enrolled children, adopting the standards was associated with an unintended consequence of increased caregiver’s frustration in getting services for the child among children with special health care needs. These findings suggest that additional policies may need to be paired with network adequacy standards to achieve the desired improvements in specialty care access for Medicaid-enrolled children, especially for children with special health care needs.

In Study 2, I examined the association between MMC penetration and access to specialty care among Medicaid-enrolled children overall, and separately by children’s special health care needs status. I found that among all Medicaid-enrolled children, MMC penetration was positively associated with caregivers reporting of feeling frustrated in getting services for the child. Furthermore, among Medicaid-enrolled children with special health care needs, MMC penetration was negatively associated with having any visit to mental health professionals. These findings suggest that as states have increasingly enrolled more children under MMC, some children may have experienced worse access to specialty care.

In Study 3, I examined the association between MMC penetration and mental health service utilization among non-elderly adults. I found that increased MMC penetration was associated with fewer days in inpatient mental health facilities among all non-elderly adults and among those with identified mental health conditions. Additionally, I observed that MMC penetration was not associated with significant changes in the use of mental health services in other settings (i.e., outpatient and prescription) or perceived unmet mental health care needs. These findings suggest that increased MMC enrollment may reduce the use of some high-cost mental health services among non-elderly adults.

Taken together, findings from this dissertation help shed light both on the potential impacts of MMC on different populations with complex health care needs, as well as the need for additional regulatory efforts for policymakers to ensure adequate specialty care access for MMC enrollees.

Table of Contents

Introduction. Page 1

Study 1: Evaluating Medicaid Managed Care Network Adequacy Standards and Associations with Specialty Care Access for Children. Page 16

Study 2: Association between Medicaid Managed Care Penetration and Specialty Care Access among Children. Page 50

Study 3: Association between Medicaid Managed Care Penetration and Mental Health Service Use among Medicaid-Enrolled Non-Elderly Adults. Page 78

Conclusion. Page 113

About this Dissertation

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School	Laney Graduate School
Department	Health Services and Research Health Policy
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management
Keyword	Access to Care Medicaid Managed Care Mental Health Medicaid Children with Special Health Care Needs Specialty Care
Committee Chair / Thesis Advisor	Wilk, Adam, Emory University
Committee Members	Cummings, Janet, Emory University Ji, Xu, Emory University

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