Changes in continuity of enrollment among high-risk children following implementation of TennCare.
BACKGROUND
TennCare, Tennessee's Medicaid managed care program, was introduced in 1994 with the goals of controlling spending and of improving access to health care.


OBJECTIVE
To assess changes in the continuity of enrollment following the implementation of TennCare for 2 groups: infants in the first year of life (defined as persons aged 0-12 months in this study) and children hospitalized with a chronic health condition (defined as persons aged 0-18 years in this study).


METHODS
Retrospective cohort analysis.


METHODS
Infants born during 1992 or 1995 to women enrolled in Medicaid or TennCare and 0- to 18-year-old children enrolled in Medicaid or TennCare who were discharged from a hospital during 1992 or 1995 with a chronic health condition.


METHODS
For infants, failure to enroll an infant in the first 30 days of life or subsequent gaps in enrollment for 7 days or longer during the first year of life. For children hospitalized with a chronic health condition, any gap in enrollment lasting 7 days or longer by 1 year after discharge from a hospital.


RESULTS
There was a reduction in the proportion of infants without continuous enrollment in the first year of life following TennCare (19.4% after vs 25.1% before TennCare; odds ratio, 0.69; 95% confidence interval, 0.67-0.72). Improvements in continuity of enrollment for infants occurred despite an increase in the proportion of infants who were not enrolled in TennCare in the first 30 days of life, even though their mother was enrolled at delivery (14.0% after vs 8.0% before TennCare; odds ratio, 1.86; 95% confidence interval, 1.78-1.96). There was a decrease in the proportion of children hospitalized with a chronic health condition who had subsequent gaps in enrollment by 1 year following discharge from a hospital (14.3% after vs 23.3% before TennCare; odds ratio, 0.52; 95% confidence interval, 0.46-0.59).


CONCLUSIONS
For infants in the first year of life and for children hospitalized with a chronic health condition, implementation of TennCare improved continuity of coverage.
Cooper
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Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn 37232-8555, USA. william.cooper@mcmail.vanderbilt.edu
Hickson
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GB
Gray
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Ray
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013714:Tennessee; D014481:United States