Children With Special Health Care Needs and Managed Care

To the Editor .— As California pediatricians specializing in treatment of children with special health care needs (CSHCN) in a state with extremely high managed care penetration, we were very interested in the recent Pediatrics article “Do Children Receiving Supplemental Security Income Who Are Enrolled in Medicaid Fare Better Under a Fee-for-Service or Comprehensive Capitation Model?”1 The article concludes that CSHCN in managed care fare better that those in fee-for-service plans. However, our close reading of the article offers potential explanations for discrepancies between our experiences and those of the families we serve and the authors’ conclusions. Based on these explanations, we urge great caution in extrapolating the results to support enrollment of CSHCN in typical Medicaid managed care plans elsewhere. First, a bit of background: California’s state program …