Has Medi-Cal’s Shift to Managed Care Changed Access to Primary Care for Children?

Although most states have expanded the role of managed care in their Medicaid programs over the past decade, insufficient research examines the impact of the transition from Medicaid fee-for-service insurance to Medicaid managed care. In particular, access to primary care for children in Medicaid managed care is understudied. Recent Medicaid reform in California moved the majority of Medi-Cal beneficiaries into mandatory managed care and had potentially serious effects on healthcare delivery for the vulnerable Medicaid population. This paper addresses changes in access to primary care for children in California Medicaid that occurred following the recent reform. Access to primary care is measured indirectly using hospitalization rates for 14 ambulatory care sensitive conditions. By studying Medi-Cal managed care penetration rates in lieu of evaluating access to primary care at the individual level, I am able to exploit the natural experiment created by the 1993 California legislation that expanded Medi-Cal managed care independent of health status. I find that access to primary care for children may have increased under Medi-Cal managed care, although the increase may have been small enough to insignificantly affect Medi-Cal policy. I would like to thank Professors Laurence Baker and Geoffrey Rothwell for their invaluable advice and patience while I have worked on this thesis. I would also like to thank my parents and my roommate, Valerie, for their support and enthusiasm for my research.