State Medicaid Managed Care Program Design for Children and Youth with Special Health Care Needs
Updated September 2020
State Medicaid agencies are increasingly providing services to children and youth with special health care needs (CYSHCN) through Medicaid managed care (MMC) delivery systems. These two maps and the accompanying chart highlight key characteristics of states’ MMC programs that serve CYSHCN. Additionally, this blog, States Are Increasing their Use of Medicaid Managed Care for Children and Youth with Special Health Care Needs, identifies trends in the design of these programs since NASHP’s last analysis in 2017.
50-State Review of Long-Term Services and Supports for CYSHCN in Medicaid Managed Care
Last Updated Dec. 2018
As health care delivery systems rapidly transform, states are redesigning their long-term services and supports (LTSS) and integrating them into Medicaid managed care programs for children and adults with special needs. These initiatives include efforts to meet the new federal Medicaid managed care rule, develop new payment models, and create specialized managed care plans. This table features states that provide LTSS to children through Medicaid managed care programs and details key elements of their LTSS structures and systems. The information was collected from the most recent publically available contracts between state Medicaid agencies and managed care organizations, Medicaid managed care program websites, and waiver applications approved by the Centers for Medicare & Medicaid Services.
How States Use Medicaid Managed Care to Deliver Long-Term Services and Supports to Children with Special Health Care Needs
A 50-State Review of Medicaid Managed Care Contracts
Blog: How States Provide Long-Term Services and Supports to Children in Medicaid Managed Care
Chart: A 50-State Review of Medicaid Managed Care Contracts
Map & Key Terms:
States Enrolling CYSHCN in MMC, by Managed Care Model
Last Updated October 2017
State Medicaid agencies increasingly are providing services to children and youth with special health care needs (CYSHCN) through Medicaid managed care (MMC) delivery systems, including risk-based managed care, primary care case management (PCCM), and prepaid health plans. This table reviews key characteristics of states’ MMC program design for CYSHCN, including enrollment, whether states define CYSHCN in their managed care contracts, use of behavioral health services in MMC, and requirements for monitoring the quality of care provided to CYSHCN. The two maps illustrate the states that are enrolling CYSHCN in Medicaid managed care, by delivery system model (risk-based managed care, PCCM, or prepaid health plan), and the states that have specialized managed care plans for certain populations of CYSHCN.
Notes on the Sources used:
General background information on state Medicaid managed care programs was collected from:
* The Center for Medicare and Medicaid Services Spring 2016 Report on Medicaid Managed Care Enrollment and Program Characteristics, 2014. Read the report here.
* The Center for Medicare and Medicaid Services individual state managed care enrollment profiles, which can be found here.
Specific Information about state Medicaid managed care arrangements was collected and analyzed from state Medicaid managed care program websites and contracts between state Medicaid agencies and managed care organizations.
This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number UC4MC28037 Alliance for Innovation on Maternal and Child Health: Expanding Access to Care for the Maternal and Child Health Population. The information or content and conclusions are those of NASHP and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US government.
States with Specialized Medicaid Managed Care Plans for CYSHCN
Last Updated Oct. 2017