Study: Sharp Enrollment Growth in Medicaid Managed Care for Youth Results in Slight Increase in Preventive Care


The receipt of preventive care for youth enrolled in Medicaid managed care fell significantly short of the annual goal set by the Centers for Medicare and Medicaid Services (CMS).

A study conducted by the Ann & Robert H. Lurie Children's Hospital of Chicago found that significant growth in youth enrollment in Medicaid managed care was linked to only a slight increase in preventive care provided to those patients. Further, the receipt of preventive care fell significantly short of the annual goal set by the Centers for Medicare and Medicaid Services (CMS), according to the study.

Nationally, the number of children under 21 years of age enrolled in Medicaid grew from 23.5 million in 2000 to 40.5 million in 2017, with the proportion of children in Medicaid managed care plans increasing from 65% to 94%, according to the study. Across this same time period, receipt of preventive care for youth in Medicaid managed care increased from 49% to 59%, falling short of the 80% annual goal set by CMS.

“We found that older children had lower rates of preventive care than younger children,” said Jennifer Kusma, MD, a physician at Lurie Children's Hospital, Instructor of Pediatrics at Northwestern University Feinberg School of Medicine and the study’s lead author, in the press release. “This pattern has been reported in other research, and it reveals an opportunity for managed care plans to help improve quality of care by encouraging preventive care visits for adolescents as well as for younger children.”

The yearly goal set by CMS, which aims for 80% of children enrolled in Medicaid receiving at least 1 visit or screen a year, is based on recommendations from the American Academy of Pediatrics and US Preventive Services Task Force. Routine screenings are critical for promptly detecting developmental delays, such as autism spectrum disorder, as well as managing adolescent health and well-being, the study authors noted.

Kusma and her colleagues used annual state-level data from CMS to assess the relationship between youth enrollment in Medicaid managed care and preventive care encounters. The services analyzed include immunizations, growth and development evaluation, anxiety and depression screening, lead level monitoring, and oral health surveillance.

Receipt of preventive care varied heavily based on geography, with 17 states showing a significant increase, 6 states showing a significant decrease, and 28 states remaining unchanged. Across all states, Tennessee showed the greatest increase in preventive care associated with Medicaid managed care, whereas North Carolina showed the greatest decrease.

"State-specific differences in the association of managed care Medicaid with preventive care for youth may include access to primary care, Medicaid reimbursement, availability of clinicians in managed care networks, and state oversight of the quality of care of Medicaid managed care organizations," Kusma said.


Increase in Medicaid managed care for youth linked to slightly more preventive care [news release]. EurekAlert; March 1, 2021. Accessed March 9, 2021.

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