The Effects Of Part C Early Intervention Policy Change
Project Number: R40 MC 26814 Grantee: University of Colorado Denver Department/Center: COHO/COR/Medicine Project Date: 04/01/2014
Beth McManus, ScD Assistant Professor 13199 E. Montview Blvd,Suite 300 Aurora, CO 80045-7204 Phone: (303) 724-5546 Email: Beth.Mcmanus@ucdenver.edu
Rationale: This project will examine the relationship between Part C eligibility and therapy service utilization, therapy access-sensitive utilization, and spending among infants and toddlers with developmental delays and disabilities. Restricting Part C eligibility appears, on the surface, to be a way for states to reduce spending. However, reductions in access to therapy can potentially lead to increased cost and utilization downstream if the needs of infants and toddlers with developmental delays and disabilities are not met. With the implementation of the Affordable Care Act, states will increasingly be faced with policy decisions related to Medicaid program funding. Restricting eligibility for Part C will continue to be an option for states even though the relationship between eligibility and total spending is not well understood. This proposed research will address the R40 MCH Policy Analysis program goals including assessing 1) MCH Title V programs to inform the design and implementation of the ACA and 2) coordination of efforts between Medicaid and Title V and Strategic Research Issue III: Services and Systems to Assure Quality of Care for MCH population.
Research Design: This policy analysis will utilize a "natural experiment" (difference-indifference design using existing de-identified claims data from three State Medicaid
Programs: Colorado, which restricted eligibility during the sample period, and two comparison states, Washington and North Carolina, which did not. Among the primary study population of children 0-18 years of age who were enrolled in fee-for-service Medicaid programs in these states, from January 1, 2006 to December 31, 2010, we will create a sub-sample for each state that includes infants and toddlers (ages birth to 36 months) with a diagnosis of developmental disability or developmental delay.
Methods: Dependent variables are therapy service utilization intensity and costs. Intensity or total dosage of therapy service delivery will be calculated based upon type, frequency, and duration of services. Therapy access-sensitive utilization will include hospitalizations and increased use of medications. Costs will be calculated based upon
fee-for-service rates. Econometric models will be used to describe the effect of
restricting EI eligibility on 1) therapy service dosage, 2) occurrence and number of
therapy access-sensitive events, and 3) costs.
Impact: Previous studies of children’s therapy service utilization have been criticized for
1) reliance on parent-report, and 2) limitations for causal inference. In this study,
administrative claims databases will be utilized to derive therapy service utilization and
the robust study design will allow for causal inference.