Who cares for Medicaid-enrolled children with chronic conditions?

Objective. To estimate generalist, pediatric subspecialist, and any subspec ialist use by Medicaid-enrolled children with chronic conditions and to det ermine the correlates of use. Methods. We analyzed Medicaid claims data collected from 1989 to 1992 from 4 states for 57 328 children and adolescents with 11 chronic conditions. We calculated annual rates of generalist, subspecialist, and pediatric subspe cialist use. We used logistic regression to determine the association of de mographics, urban residence, and case-mix (Adjusted Clinical Groups) with t he use of relevant pediatric and any subspecialist care. Results. Most children with chronic conditions had visits to generalists (r ange per condition: 78%-90% for children with Supplemental Security Income [SSI] and 85%-94% for children without SSI) during the year studied. Fewer children visited any relevant subspecialists (24%-59% for children with SSI and 13%-56% for children without SSI) or relevant pediatric subspecialists (10%-53% for children with SSI and 3%-37% for children without SSI). In ge neral, children who were more likely to use pediatric subspecialists were y ounger, lived in urban areas, were white (only significant for non-SSI chil dren), and had higher Adjusted Clinical Groups scores. Use of any subspecia lists followed a similar pattern except that urban residence is statistical ly significant only for children with SSI and the youngest age group does n ot differ from the oldest age group for children without SSI. Conclusions. Children who had chronic conditions and were enrolled in Medic aid received a majority of their care from generalist physicians. For most conditions, a majority of children did not receive any relevant subspecialt y care during the year and many of these children did not receive care form providers with pediatric-specific training.