title: Gaps in enrollment from a Medicaid managed care program: effects on emergency department visits and hospitalizations for children with asthma.
abstract: BACKGROUND
  For high-risk children with asthma enrolled in Medicaid, loss of Medicaid coverage is a potential threat to access to quality asthma care.
  
  
  OBJECTIVE
  We sought to quantify the effect of gaps in enrollment on emergency department visits and hospitalizations for children with asthma in TennCare, Tennessee's managed care program for Medicaid-eligible and uninsured children.
  
  
  METHODS
  Children with asthma were identified from a research database of files maintained by the state. Gaps in enrollment in the state insurance program were measured between 1998 and 2002. Children with gaps were compared with children without gaps with respect to emergency department visits and hospitalizations for asthma, respiratory illnesses, croup, and other diagnoses.
  
  
  RESULTS
  Among children who met study definitions of asthma, 2373 experienced a gap in enrollment during the study period (10.4%). The rate of hospitalizations and emergency department visits for children with gaps (7402/10,000 person years) was significantly lower than the rate of study events for children with no gaps (9230/10,000 person years) (adjusted incidence rate ratio 0.88; 95% confidence interval 0.81-0.96). The rate of hospitalizations for asthma and other respiratory conditions was not different between the 2 groups; however, there was a significantly lower rate of hospitalizations for other reasons for children with gaps (adjusted incidence rate ratio 0.59; 95% confidence interval 0.41-0.86).
  
  
  CONCLUSIONS
  Children with asthma who had gaps in a Medicaid managed care insurance program had no increase in asthma related emergency department visits and hospitalizations. Children who had gaps did have fewer nonrespiratory emergency department visits and hospitalizations than their non-gap counterparts. Further study is needed to explore the reasons for this unexpected finding.
authors.affiliation: Division of General Pediatrics, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-8555, USA. william.cooper@vanderbilt.edu
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
authors.forename: James R
authors.initials: JR
authors.lastname: Daugherty
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Ray
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008329:Managed Care Programs; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D013714:Tennessee