The Influence of National Standards on Medicaid Managed Care Programs: Implications for Children and Youth with Special Health Care Needs
This article describes how the National Standards for Systems of Care for Children and Youth with Special Health Care Needs served as a framework for the redesign of two state Medicaid managed care programs. Findings from the study indicate that managed care leaders viewed the Standards as an impetus to sharpen quality improvement and foster whole-person care. Florida translated the Standards into contract provisions and uses them to hold managed care organizations accountable to performance targets specific to CYSHCN. In Colorado, the Standards were used to develop contract provisions with regional accountable entities (RAEs) and ensure that RAEs meet their obligations to CYSHCN. The National Standards offer a flexible framework to help states design Medicaid managed care programs and improve systems of care for CYSHCN. States can learn from one another’s experiences applying the Standards in the context of their policy environments.