Trends in Medicaid expenditures for a comprehensive care coordination program serving children with chronic disease: a longitudinal perspective

Children and young adults with chronic diseases benefit from comprehensive healthcare services that address their physical health and social and emotional needs. A comprehensive health care program called Coordinated Healthcare for Complex Kids(CHECK) offered specialized medical, dental, behavioral health, and social services to children, adolescents, and young adults with one or more chronic medical conditions who were enrolled in Medicaid. Staffing and management procedures for the program were specifically designed to be cost effective. The goal of this research was to assess program expenditures over a nearly 5 year period. Medicaid records were used to collect cost data for program participants before participation and for the following 58 months. A segmented regression analysis was used to evaluate spending trends across three periods: (1) pre CHECK implementation participation, (2) grant-funded implementation, and (3) self-funded implementation. There were no significant differences between the pre-implementation and grant-funded periods. There was a significant decrease then upward trend in the self-funded period. Medicaid expenditures for this comprehensive care program remained stable through the grant-funded implementation period. Changes were found during the self-funded implementation period. Contracts and agreements during the self-funded period focused on specific subpopulations and services which may have affected expenditures. Examination of determinants of cost effects when funding sources change bears further investigation.