ObjectiveWe explored the current state of developmental screens, child development services, mechanisms to fund screens and services, and incentives for adopting new services within managed care organizations serving Medicaid enrolees. DesignNational, cross-sectional mail survey. Sample/settingSurvey of 388 Medicaid managed care organizations (MMCO) enrolling children in 1998-99. ResultsMost of the 155 plans that responded provided an array of developmental screenings and services, funded primarily through internal mechanisms or under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) programs. Plan contacts expressed interest in implementing new services, particularly if additional funding was available. The most important motivators included requiring services in the Medicaid contract, enhanced capitation rates, and demonstration that providing child development services would reduce other utilization costs. ConclusionsIf state Medicaid agencies want to enhance the child development services available through health plans, they could initiate steps such as requiring child development services in contracts with plans or providers; revising EPSDT language and engaging in more consistent enforcement; and enhancing capitation rates. More research on effectiveness and benefits of specific developmental screens and services is needed.
Objective. We sought to understand why certain Medicaid managed care organizations (MMCOs) implemented child development services or programs and how they had done so. We also sought to identify barriers and facilitators to successful initiation and implementation of child development programs. Methods. We conducted 9 key informant interviews and 4 site visits, and performed qualitative analyses to identify major themes across responses. Results. We identified a small number of MMCOs with child development services. High-level support was crucial for program initiation; physician buy-in, staff support, and strong working relationships with outside health professionals or agencies were principal factors in successful program implementation. Conclusions. MMCOs that were committed to implementing child development services were successful in doing so, without external funding or regulatory mandate. The results provide valuable strategies for MMCOs interested in developing programs and for researchers and advocates interested in promoting child development services for low-income children.
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