| Background. Children with special health care needs constitute at least one-fifth of children enrolled in public health insurance programs. Few studies have addressed experiences with care among children with special health care needs enrolled in Medicaid and SCHIP managed care plans.; Objectives. (1) To identify factors associated with negative experiences with care among children enrolled in Maryland's Medicaid/SCHIP managed care plans; (2) to examine differences in experiences with care between special needs children and healthier children, paying particular attention to children requiring the use of mental health and therapy services that have been "carved out" of health plan capitations; and (3) to examine differences between respondents and non-respondents.; Findings. After controlling for demographic, caregiver, health status, plan, and regional factors, children requiring mental health services and occupational, physical or speech therapy services (i.e., carve-out services) reported greater problems with access to and timeliness of care than other children; this was largely true regardless of whether special needs children were defined using claims/encounter data or using caregiver reported information. After controlling for other factors, children with caregivers who did not speak English were more than twice as likely to report problems on all reporting measures except plan customer service. Regional differences proved more important than health plans in explaining problems with care after controlling for other factors. Survey non-respondents were more likely than respondents to be urban, non-white, younger, lower-income, and healthy.; Conclusions. Conducting an in-depth, individual-level analysis of CAHPS measures can provide state Medicaid/SCHIP programs with additional information for quality assessment and improvement. Maryland should consider the following: eliminating the special therapy carve-out; conducting additional quality monitoring activities for children with mental health problems; and targeting linguistic minorities in its quality improvement efforts. Additionally, thought should be given to tracking and trending CAHPS data regionally. Finally, because caregivers of sicker children are more likely to report negative experiences with care, the study provides some evidence that unadjusted plan-level scores may be biased in a negative direction. (Abstract shortened by UMI.)... |
