Healthplan Magazine Looks at Two Medicaid Managed Care Programs Targeting Children With ‘Special Needs’
Wraparound Milwaukee in Milwaukee, Wis., and the Family Maintenance Healthcare Demonstration Project (FMHDP) in Los Angeles County, Calif., are two examples of Medicaid managed care programs that are "going out of their way" to treat children with "special needs" through community and home-based regimens, Healthplan reports in an article profiling the two programs. Healthplan, a magazine focused on the managed care industry, reports that according to HRSA's Maternal and Child Health Bureau, children with special needs are defined as those "who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally." The 1994 National Health Interview Survey revealed that 17% of children eligible for Medicaid fall into this category, making them "only a small proportion of the population Medicaid managed care plans serve."
Wraparound Milwaukee
Wraparound Milwaukee, which is operated by the Mental Health Division of the Milwaukee County Human Services Department and was launched five years ago, currently serves about 1,000 children and adolescents each year. The youths are "ordered" into the program by the Milwaukee County Children's Court as an alternative to placement in a treatment facility. Each child is assigned to a case manager who works with the child and a "family team" -- which includes parents or other caretakers, relatives, friends, peers or others -- to design a "specialized treatment plan" that emphasizes community and personal resources that can help meet the child's needs. The approach combines "[f]ormal services," such as outpatient therapy or alcohol and substance abuse counseling, with "informal services" such as peer groups or community activities. The program also employs a Mobile Urgent Treatment Team, which is on call 24 hours a day, to "immediately" respond to emergency situations and "prevent an inpatient psychiatric placement or other residential placement." Wraparound Milwaukee operates on an annual budget of about $28 million. However, by treating children through community programs instead of residential treatment centers, Wraparound Milwaukee saves the state about $3,000 per month per child. In addition, residential treatment placement for these children has dropped from an average of 400 placements per day to about 130, and inpatient psychiatric hospitalization has dropped from 5,000 days per year for the group to about 200 days. Wraparound Milwaukee has attracted the attention of other states, including New Jersey, Nebraska, Delaware, Connecticut.
L.A. Children
FMHDP, which is "just getting off the ground," is managed by L.A. Care, the nation's largest "Medicaid and publicly governed health plan," Healthplan reports. Its planning and implementation costs are being financed through nearly $500,000 in grants from the Center for Health Care Strategies under its Medicaid Managed Care Program. L.A. Care, which serves more than 600,000 individuals in Los Angeles County, provides care through seven partner health plans and 3,500 primary care physicians. FMDHP targets children who are enrolled in the L.A. County Department of Children and Family Services' Family Maintenance Program because of problems such as domestic violence or abuse. Parents enrolling their children in the program first sign a consent form releasing "private and often sensitive information" about a child's medical history or family situation, including information on domestic violence or substance abuse in the family. Physicians are given this data so they have "a complete picture of [the children's] health," Healthplan reports. Each child and family is assigned a care coordinator who serves as a link between the primary care physician, other health care providers and the Department of Children and Family Services. The care coordinator is tasked with ensuring that the child receives "all needed care," including an initial health screening and testing for developmental, mental or psychosocial disorders. L.A. Care hopes to enroll 100 children and their families in the plan by December, but Barbara Friedman, L.A. Care's director of community benefit strategies and program innovation, admits that getting families to sign up will prove difficult. "Families told us clearly they have a certain level of discomfort with imparting sensitive information and letting physicians and office staff know they are in the Family Maintenance Program. Only time will tell whether families are eager or reluctant to join," Friedman said (Allen/Oehlmann, Healthplan, May/June 2001).
