Implications of eligibility category churn for pediatric payment in Medicaid.
Am J Manag Care
; 25(3): 114-118, 2019 03.
Article
em En
| MEDLINE
| ID: mdl-30875179
ABSTRACT
OBJECTIVES:
To describe the extent and implications of "churn" between different Medicaid eligibility classifications in a pediatric population (1) aged, blind, and disabled (ABD) Medicaid eligibility, determined by disability status and family income; and (2) Healthy Start Medicaid eligibility, determined by family income alone. STUDYDESIGN:
As a result of a 2013 policy change, children with ABD eligibility transitioned from fee-for-service to capitated care. We used Ohio Medicaid claims data from July 2013 through June 2015 to explore the relationships among instability in eligibility category, demographics, and utilization.METHODS:
To examine the potential financial effect of categorical churn, an effective capitation rate was created to capture the proportion of the maximum potential capitation rate that was realized.RESULTS:
More than 20% of children exited ABD-based eligibility at least once. Switching was associated with younger age and rural residence and was not associated with healthcare use.CONCLUSIONS:
Switching between eligibility categories is common and affects average capitation but not health service use.
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Temas:
ECOS
/
Aspectos_gerais
Bases de dados:
MEDLINE
Assunto principal:
Medicaid
/
Definição da Elegibilidade
/
Serviços de Saúde
Aspecto:
Determinantes_sociais_saude
Limite:
Child
/
Child, preschool
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2019
Tipo de documento:
Article