Impact of the Oregon health plan on children with special health care needs

Objective. Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with spe cial health care needs fare under such programs. Of particular concern is t he ability of such children to navigate a managed care system and gain acce ss to specialty and other services. This study compares the managed care ex periences of children with and without special care needs in the Oregon Hea lth Plan. Methodology. Telephone surveys were conducted with a sample of parents of c hildren enrolled in the Oregon Health Plan. Three groups of children were s ampled: Supplemental Security Income (SSI) children with disabilities, chil dren with asthma, and children without special health care needs. Descripti ve and multivariate analyses were conducted to determine the impact of Medi caid managed care on access and satisfaction. Results. Children with disabilities in managed care plans did not experienc e any more difficulty accessing needed specialty care than did those withou t special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabil ities remaining in fee-for-service. Conclusions. Unlike SSI children with disabilities, children who were not S SI-eligible but had asthma seemed to have difficulty obtaining some service s. These children were not eligible for the same consumer protections affor ded SSI children by Oregon. If states want to enroll all children with spec ial health care needs into managed care programs, they must develop mechani sms for identifying such children and ensuring that they receive medically necessary services.