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 Best Clinical and Administrative Practices (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.


  • Access II Care of Western North Carolina, North Carolina
  • Community First Health Plan, Texas
  • Community Health Network, Connecticut
  • Health Services for Children with Special Needs, Inc., District of Columbia
  • HealthNet, California
  • Keystone Mercy Health Plan, Pennsylvania
  • Lovelace Community Health Plan, New Mexico
  • Maryland Physicians Care, Maryland
  • Medically Fragile Children’s Program, South Carolina
  • Molina Healthcare, Washington
  • Neighborhood Health Plan, Massachusetts
  • Partnership HealthPlan, California