Evaluation of the District of Columbia's Demonstration Program,Managed Care System for Disabled and Special Needs Children: Year One Report

This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. The demonstration program relies on a Medicaid-financed managed care system for children in the District's Supplemental Security Income program and is offered to eligible children as an alternative to the traditional Medicaid fee-for-service system. Enhanced Medicaid benefits through the demonstration program include individual treatment plans, respite care, van transportation and taxi vouchers, care management services and limited use phones. The Medicaid payment system includes risk sharing based on 85% risk corridors (as defined by medical loss ratios) between the District's Medicaid office and the non-profit health plan operating the demonstration, a capitated payment system for the health plan, and negotiated fee schedules for providers. This evaluation considers access and cost issues, placing considerable emphasis on issues related to quality of care and satisfaction. The research design centers on three main activities: (1) analyses of the implementation of the demonstration; (2) analyses of enrollment which will describe which children enroll and disenroll in this type of system; and (3) outcomes analyses that document the experiences of the District, plan, providers, children and families. The study of the implementation of the demonstration is based on interviews, a series of site visits to the District's Medicaid office and HSCSN, and review of the documentary record. [125 PDF pages]