Evaluation of the District of Columbia's Demonstration Program, Managed Care211 System for Disabled and Special Needs Children. Final Report and Executive 211 Summary

摘要

This project evaluates the District of Columbia's managed care demonstration211u001eprogram for disabled and special needs children. The demonstration program relies 211u001eon a Medicaid-financed managed care system for children in the District's 211u001eSupplemental Security Income (SSI) program, and is offered to eligible children 211u001eas an alternative to the traditional Medicaid fee-for-service system. Enhanced 211u001eMedicaid benefits through the demonstration program include individual treatment 211u001eplans, respite care, van transportation and taxi vouchers, care management 211u001eservices and limited-use phones. The Medicaid payment system includes risk 211u001esharing based on 85 percent risk corridors (as defined by medial loss ratios) 211u001ebetween the District's Medicaid office and the non-profit health plan operating 211u001ethe demonstration, a capitated payment system for the health plan, and negotiated 211u001efee schedules for providers. This evaluation considers access and cost issues, 211u001eplacing considerable emphasis on issues related to quality of care and 211u001esatisfaction. The research design centers on three main activities: (1) analyses 211u001eof the implementation of the demonstration; (2) analyses of enrollment which will 211u001edescribe which children enroll and disenroll in this type of system; and (3) 211u001eoutcomes analyses that document the experiences of the District, plan, providers, 211u001echildren and families. The study of the implementation of the demonstration is 211u001ebased on interviews, a series of site visits to the District's Medicaid office 211u001eand HSCSN, and review of the documentary record. This project was co-funded by 211u001ethe Health Care Financing Administration (HCFA).