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Research Questions

  1. What are stakeholders' perceptions of the transition from prior 1915(c) waivers to the Children's Design?
  2. What are the consequences of targeting availability of HCBS to a more narrowly defined population?
  3. To what extent are children with special needs accessing primary care providers who understand those needs?
  4. To what extent are MMC enrollees accessing HCBS in a timely manner that results in improved health care outcomes?
  5. To what extent are HCBS enrollees accessing primary care, other health monitoring and prevention services, and specialized care for chronic health and behavioral health conditions?

In an effort to streamline care for children and youth under age 21 with needs for home- and community-based services (HCBS), New York State consolidated several prior 1915(c) waivers into a single Children's Waiver and amended their Section 1115 Medicaid Redesign Team waiver. The 1115 waiver amendment allows the state to move services covered by the consolidated Children's Waiver from fee for service to Medicaid managed care (MMC) and to target eligibility to medically needy family-of-one children who meet clinical criteria and are enrolled in the consolidated Children's Waiver but do not qualify for Medicaid due to family income. Together, these waiver amendments are called the "Children's Design," which was implemented in 2019.

In this interim evaluation, the authors identify facilitators of, and barriers to, implementation of the Children's Design and describe baseline trends in outcomes of interest to its future evaluation. The authors found that: (1) providers, advocates, MMC plan representatives, and government partners perceived the transition to the Children's Design as challenging and were particularly concerned about the burden of accessing care on children's families and reductions in service availability; (2) prior to the Children's Design implementation, parents of children with chronic conditions had high levels of satisfaction with their primary care providers but were less satisfied with their ability to access special equipment and therapies and with coordination efforts among multiple providers; and (3) at baseline, the levels of quality indicators for children did not change significantly, with the exception of some primary care indicators for young children, which improved.

Key Findings

  • Providers, advocates, Medicaid Managed Care plan representatives, and government partners perceived the transition to the Children's Design as challenging and were particularly concerned about the burden of accessing care for children's families and reductions in service availability.
  • Prior to the implementation of the Children's Design, parents of children with chronic conditions had high levels of satisfaction with their primary care providers but were less satisfied with their ability to access special equipment and therapies and with coordination efforts among multiple providers.
  • Prior to the implementation of the Children's Design, the levels of quality indicators for children did not change significantly, with the exception of some primary care indicators for young children, which improved.

Recommendations

  • To further examine the processes of eligibility determinations, Health Home enrollment, and HCBS access and utilization, with a focus on reducing the burden on families and providers.
  • To improve existing or develop new initiatives to educate families, providers, and MMC plan managers to help improve understanding of the new eligibility determination, enrollment, and care coordination processes.
  • To gain access to individual-level data to allow for the identification of the target population, tracking of the same individuals over time, and establishing a valid comparison group for the summative evaluation.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Demonstration Description

  • Chapter Three

    Study Design

  • Chapter Four

    Evaluation Findings

  • Chapter Five

    Discussion and Implications

  • Chapter Six

    Interactions with Other State Initiatives

  • Appendix A

    Key Stakeholder Interview Protocol

  • Appendix B

    Qualitative Coding

  • Appendix C

    Statistical Test Results for Quality Measures

  • Appendix D

    Baseline Quality Measures for the Children's Design Target Population, Overall Medicaid Program, and Comparable States

Research conducted by

This research was sponsored by the New York State Department of Health and conducted by RAND Health Care.

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