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The American Journal of Managed Care March 2019
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Incorrect and Missing Author Initials in Affiliations and Authorship Information
From the Editorial Board: Austin Frakt, PhD
Austin Frakt, PhD
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Implications of Eligibility Category Churn for Pediatric Payment in Medicaid

Deena J. Chisolm, PhD; Sean P. Gleeson, MD, MBA; Kelly J. Kelleher, MD, MPH; Marisa E. Domino, PhD; Emily Alexy, MPH; Wendy Yi Xu, PhD; and Paula H. Song, PhD
Analyses of Ohio Medicaid claims data from 2013 to 2015 reveal that instability among eligibility categories is common and affects average capitation but not health service use.
ABSTRACT

Objectives: To describe the extent and implications of “churn” between different Medicaid eligibility classifications in a pediatric population: (1) aged, blind, and disabled (ABD) Medicaid eligibility, determined by disability status and family income; and (2) Healthy Start Medicaid eligibility, determined by family income alone.

Study Design: As a result of a 2013 policy change, children with ABD eligibility transitioned from fee-for-service to capitated care. We used Ohio Medicaid claims data from July 2013 through June 2015 to explore the relationships among instability in eligibility category, demographics, and utilization.

Methods: To examine the potential financial effect of categorical churn, an effective capitation rate was created to capture the proportion of the maximum potential capitation rate that was realized.

Results: More than 20% of children exited ABD-based eligibility at least once. Switching was associated with younger age and rural residence and was not associated with healthcare use.

Conclusions: Switching between eligibility categories is common and affects average capitation but not health service use.

Am J Manag Care. 2019;25(3):114-118

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