Medicaid managed care and children with special health care needs: a case study analysis of demonstration waivers in three states.

Although the number of states moving toward managed care for Medicaid beneficiaries is increasing, little is known about the extent to which managed care delivery systems are prepared to address the special needs of children with chronic illness and disabilities. This study explores the change in the process of care provided by the State Title V Programs for Children With Special Health Care Needs (CSHCN) and in parent and provider satisfaction when Medicaid changes the method of payment from fee-for-service to capitation. The findings suggest that CSHCN are vulnerable in a managed care environment and that states should proceed cautiously to integrate this population into their managed care arrangements.