Committed to improving the health and well-being of all people across every state.

Medicaid Managed Care for Children and Youth with Special Health Care Needs: 50-State Scan

State Medicaid agencies continue to serve children and youth with special health care needs (CYSHCN) through Medicaid managed care (MMC) delivery systems. In early 2023, NASHP reviewed Medicaid waivers, state plan amendments, and managed care contracts to analyze how states enroll children in MMC and identify key provisions for CYSHCN.

The two maps and chart below provide an overview of the findings. Additionally, NASHP’s blog, “How States Promote the Provision of Quality Care to CYSHCN Enrolled in Medicaid Managed Care: Findings from a 50-State Analysis,” includes detailed analysis of the results and trends since the last scan in 2020.

Key Findings

  • 48 states and Washington, DC enroll children into MMC programs. 
  • 11 states and Washington, DC enroll particular groups of children, including CYSHCN, into specialized MMC programs serving only that population. All but one of these states also enrolls children into an MMC program that serves both children and adults.
  • At least 30 states and Washington, DC include one or more of the following specific provisions for CYSHCN in their MMC contracts: 1) definition of CYSHCN, 2) quality provisions for CYSHCN, and 3) requirement for managed care entities to partner with Title V Maternal and Child Health (MCH) Block Grant programs.

Endnotes

Please note: MMC programs that only serve specialized populations involved in child welfare are included in the map but not the chart above. Analysis of these programs is available in a NASHP scan from May 2022

* Specific details on enrollment of this population are provided in the “Additional Enrollment Information” column.

^ Provisions in the Medicaid managed care contract apply to members with special health care needs broadly but not specifically to children and youth in that population (i.e., CYSHCN).

(1) MCMC is operated through six different models, which vary by county and region: 1) County-Organized Health System (COHS): Beneficiaries are served by a single plan that is created and administered by a county’s board of supervisors, or other local health authority; 2) Two-Plan: Beneficiaries choose between a single publicly run entity known as a local initiative plan and a single commercial plan; 3) Geographic Managed Care (GMC): Beneficiaries choose from multiple commercial plans; 4) Regional: Beneficiaries choose between two or more commercial plans operating in 18 contiguous counties as one service area; 5) Imperial: Beneficiaries in Imperial County choose between two commercial plans; 6) San Benito: Beneficiaries in San Benito County choose between a single commercial plan and Medi-Cal fee-for-service (FFS).

(2) All contractors participating in specialized Medicaid managed care programs are subject both to the provisions in the Managed Medical Assistance (MMA) program contract and also those of each specialized contract attachment.

(3) Primary Care Plus replaced Maine’s PCCM program in 2022, but it is unclear if it is a PCCM program.

(4) Virginia has begun transition to Cardinal Care, merging the two managed care plans (Medallion 4.0 and Commonwealth Coordinated Care Plus) into one plan. The Cardinal Care contract is not yet available as of 5/2/2023.

Sources

NASHP collected the above data from two types of documents for each Medicaid managed care program covering children: 1) the federal authority for the Medicaid managed care program (i.e., the waiver or state plan amendment authorizing MMC) and 2) the Medicaid managed care contract (for MCO and PIHP) or provider agreement (for PCCM). The federal authority documents informed data on enrolled populations, while the contracts and provider agreements were used for contract provision data. NASHP only analyzed contracts and provider agreements that were publicly available online, and a note was added when unavailable.

Acknowledgements

Several NASHP staff contributed to this tracker through input, guidance, and/or draft review, including Karen VanLandeghem and Heather Smith.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under co-operative agreement number UD3OA22891, National Organizations of State and Local Officials. The information, content, and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.

Search

Sign Up for Our Weekly Newsletter

* indicates required
Please enter a valid email address.
Areas of Interest