![]() When parents did not choose a plan for their child within 30 days, the child was auto-assigned to a plan. If the parent did not select a plan within 2–3 weeks, their information was referred to a local community-based organization who attempted to contact the parent to encourage choice of a plan. Parents of children enrolling in Michigan Medicaid were given the option of choosing a managed care plan when more than one plan operated in their county. During the period of this study (2005–2008), infants were eligible for Michigan Medicaid if household income was ≤185 % of the federal poverty level. Michigan Medicaid has had mandatory managed care for most populations statewide since 1995, including healthy children. These possibilities raise concern about the potential for low interaction with primary care and increased reliance on the emergency department (ED) for auto-assigned children. Auto-assignment could also represent a lower priority placed on preventive primary care by some parents. Alternatively, the lack of plan selection by parents could be an endogenous marker for other factors associated with health care utilization, such as pre-existing barriers to care, including language differences, low literacy, parental mental health problems, or other complex social needs. ![]() In addition to potential mismatches between family’s needs and plan services, auto-assignment could disrupt primary care continuity if the child is assigned to a plan that their current provider does not accept. There are compelling reasons to examine the association between auto-assignment and health care utilization for children in Medicaid. However, there are few published studies of auto-assignment, and none that examine associations between auto-assignment and health care utilization at the patient level. Early in the advent of Medicaid managed care, concerns were raised about the potential for auto-assignment to lead to geographic, cultural, or linguistic mismatches between enrollees and their managed care plan and primary care provider, resulting in negative effects on preventive health care utilization. This process is typically referred to as auto-assignment. ![]() When enrollees do not choose a managed care plan, Medicaid programs need a mechanism to assign enrollees to a plan. When managed care is mandatory, Medicaid enrollees are typically given a choice of more than one plan. The economic recession and related state budget crises have accelerated states efforts to shift more Medicaid enrollees into mandatory managed care. In 2009, over 70 % of Medicaid enrollees nationally were enrolled in some form of managed care, and healthy children are a key target group for mandatory managed care enrollment. Most states have turned to mandatory managed care in Medicaid as a mechanism to meet goals for controlling costs while maintaining or improving access and quality. Future work is needed to understand mechanisms of differences in utilization, but auto-assigned children may represent a target group for efforts to promote pediatric preventive care in Medicaid. Auto-assigned infants were less likely to use preventive and acute primary care but only slightly more likely to use emergency care. All results were significant in multivariable analyses. 5, p < 0.001) but were only slightly more likely to have 2 or more ED visits (51 vs. Auto-assigned infants had fewer acute office visits (median: 4 vs. 53 %, p < 0.001) and to be up-to-date on immunizations at 12 months of age (75 vs. Auto-assigned infants were less likely to meet goal number of WCVs in 18-months of managed care enrollment (32 vs. Chi squared and rank-sum tests and logistic and negative binomial regression were used in bivariate and multivariable analyses for dichotomous and count data, respectively. Auto-assigned infants were compared versus chosen plan infants on: (1) well-child visits (WCVs) (2) immunizations (3) acute office visits and (4) ED visits. Medicaid encounter and state immunization registry data were then acquired. Medicaid administrative data were used to identify all children 0–3 months of age at enrollment in Michigan Medicaid managed care in 2005–2008 with 18-months of subsequent enrollment. To test the hypothesis that infants auto-assigned to a Medicaid managed care plan would have lower primary care and higher emergency department (ED) utilization compared to infants with a chosen plan.
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