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Care Coordination for Children With Special Needs in Medicaid: Lessons From Medicare
Kate A. Stewart, PhD, MS; Katharine W.V. Bradley, PhD, MBA; Joseph S. Zickafoose, MD, MS; Rachel Hildrich, BS; Henry T. Ireys, PhD; and Randall S. Brown, PhD
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Care Coordination for Children With Special Needs in Medicaid: Lessons From Medicare

Kate A. Stewart, PhD, MS; Katharine W.V. Bradley, PhD, MBA; Joseph S. Zickafoose, MD, MS; Rachel Hildrich, BS; Henry T. Ireys, PhD; and Randall S. Brown, PhD
As increasing numbers of children with special healthcare needs move into Medicaid managed care, health plans can improve care coordination using evidence from Medicare.
Finally, all of the successful Medicare care coordination programs used nurses as care coordinators, due to the complex medical conditions of the patients. This suggests that achieving desired outcomes for beneficiaries, who almost always have complex healthcare needs, tends to require care coordinators with the clinical knowledge of nurses. Although this is likely true for some CSHCN, others may have needs that are best addressed by nonclinical care coordinators or by a combination of clinical and nonclinical experts on the care coordination team.

CONCLUSIONS

There is no one-size-fits-all design for implementing a care coordination program for CSHCN, given the diversity of conditions and medical needs, familial capacity to coordinate care, locally available resources and funding, and social determinants of health among Medicaid-eligible children. States and MMCOs may want to implement some of the 6 design elements presented here in different ways for different populations within the same state. Setting specific goals for care coordination programs—for example, emphasizing improved well-being and functional status or reduced utilization and spending—may also require placing relatively greater emphasis on certain design elements. Policy makers and MMCOs should continue to look for rigorous evidence on care coordination programs for CSHCN and consider conducting their own evaluations to assess program effects and the elements of programs that contribute to them. Similarly, there is no single perfect Medicaid financing or eligibility mechanism by which states can provide care coordination to CSHCN. As Medicaid leaders consider the options for care coordination programs, they may wish to combine traditional sources of funding for Medicaid managed care with others that target particular groups of CSHCN. Ultimately, no matter how states choose to implement care coordination for CSHCN, the evidence discussed here can help states and MMCOs develop successful programs, set appropriate expectations for outcomes, and better meet the needs of the CSHCN under their care.

Acknowledgments

The authors thank the following experts who graciously provided them with feedback on their preliminary findings: Rich Antonelli (Boston Children’s Hospital/Harvard Medical School), Arvind Goyal (Illinois Medicaid), Kay Johnson (Johnson Group Consulting, Inc), Jennifer Lail (Cincinnati Children’s Hospital Medical Center), Carolyn Langer (Massachusetts Medicaid [MassHealth]), Doris Lotz (New Hampshire Medicaid), Steven Merahn (U.S. Medical Management and Centria Healthcare), Robert Moon (Alabama Medicaid), Jill Morrow-Gorton (Massachusetts Medicaid [MassHealth]), Ed Schor (Lucile Packard Foundation for Children’s Health), and Karen Spencer (Boston Children’s Hospital/Harvard Medical School).

Author Affiliations: Mathematica Policy Research, Chicago, IL (KAS), Ann Arbor, MI (KWVB, JSZ, RH), Washington, DC (HTI), Princeton, NJ (RSB).

Source of Funding: Support for this research was provided by the Lucile Packard Foundation for Children’s Health. The views presented here are those of the authors and not necessarily those of the Foundation or its directors, officers, or staff.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (KAS, KWVB, JSZ, RH, HTI, RSB); acquisition of data (KAS, KWVB, RH, RSB); analysis and interpretation of data (KAS, KWVB, JSZ, HTI, RSB); drafting of the manuscript (KAS, KWVB, JSZ, RSB); critical revision of the manuscript for important intellectual content (KAS, KWVB, JSZ, HTI, RSB); obtaining funding (KAS, HTI, RSB); administrative, technical, or logistic support (RH); and supervision (KAS, RSB). 

Address Correspondence to: Kate A. Stewart, PhD, MS, Mathematica Policy Research, 111 E Wacker Dr, Ste 920, Chicago, IL 60601. Email: kstewart@mathematica-mpr.com.
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