State-Level Managed Care Penetration in Medicaid and Rates of Preventive Care Visits for Children

Jennifer D. Kusma*, Jenifer Cartland, Matthew M. Davis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To examine time trends in receipt of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in serial cohorts of Medicaid beneficiaries <21 years, as Medicaid managed care (MMC) was adopted by states. Methods: Using annual state-level data from the Centers for Medicare & Medicaid Services, we performed national analyses of Medicaid beneficiaries <21 years from 2000 to 2017. We used generalized linear models to assess the relationship between MMC enrollment and EPSDT encounters, accounting for repeated measures, first at the national level overall and then specifying random effects at the state level. Results: From 2000 to 2017, there was an increase at the national level in Medicaid beneficiaries <21 years enrolled in MMC, from 65% to 94%. At the national level, for every additional 100 enrollees in MMC there was an associated increase of 36 beneficiaries with an EPSDT visit (95% confidence interval: 19–53; P < .001). When accounting for state-level variation, for every additional 100 enrollees in MMC, there was an increase of 6 beneficiaries with an EPSDT visit (95% confidence interval: 2–10; P = .003). Examining the association between MMC penetration and EPSDT participation within each state, including the 50 states and Washington DC, there were 17 states with a significant positive association between MMC ratio and EPSDT participation, and 6 states with a significant negative association. Conclusions: As managed care has become the predominant form of Medicaid coverage, there has been a modest increase in preventive visits as indicated by EPSDT participation, with marked variation across states.

Original languageEnglish (US)
Pages (from-to)1338-1344
Number of pages7
JournalAcademic Pediatrics
Volume21
Issue number8
DOIs
StatePublished - Nov 1 2021

Keywords

  • EPSDT
  • Medicaid
  • managed care
  • preventive care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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