Children with special health care needs account for 76 percent of total Medicaid expenditures, even though they represent less than 30 percent of the entire population. While many states rely on fee-for-service arrangements to meet the specialized needs of these children, more states are exploring managed care alternatives to increase quality and cost efficiencies. Because of the intense and diverse care requirements of children with special needs, designing managed care programs that offer high-quality and cost-effective care for this population is a complex undertaking.
The goal of the BCAP Improving Managed Care for Children with Special Needs workgroup was to develop and pilot strategies to improve the quality of care for children with special needs enrolled in Medicaid and SCHIP. The workgroup, consisting of chief medical officers and decision makers from leading Medicaid health plans across the country, identified and piloted best practices for children with special needs. Plans focused on creating a "Medical Home," cultural competency, risk adjustment, and consumer relations.