June 2015

Children's Health Care in the HUSKY Program: Impact of Converting from Risk-Based Managed Care to an Administered Fee-for-Service Medicaid Program

Mary Alice Lee, Ph.D. and Kenneth Feder

Connecticut Voices for Children conducted a descriptive study of children’s health services utilization before and after HUSKY Program changes in 2012.

Changes in administrative and fiscal arrangements for the program had a modest impact thus far on trends in children’s medical care utilization in 2012 and 2013, compared with 2007-2011. Specifically, we found that:

  • Primary care: In 2013, 90 percent of children had at least one ambulatory care visit with providers who submitted claims for reimbursement.  Over time, the distribution across primary care visits shifted toward well-child care, with fewer children having had problem-oriented care only. 
  • Well-child care: In 2013, two of every three children (66.2%) had well-child care, up from the five-year average in the final years of risk-based managed care (60.6%).
  • Emergency care:  In 2013, nearly 39 percent of children had at least one emergency room visit, essentially unchanged from the five-year average under risk-based managed care (38.2%) but down slightly from the highest rate reported in recent years (41.6% in 2009).

The impact of additional program enhancements may not have been fully realized in the first two years since these administrative and financing changes.  In addition, reimbursement for primary care increased in 2014 under the Affordable Care Act.  The Department and its contractors should continue to track trends in children’s health care utilization, with additional studies of high emergency care utilization rates.

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