Shanna Shulman

Shanna Shulman

Director of Health and Medical Research, Richard and Susan Smith Family Foundation

Dissertation Title:  "Evaluating Infant Experience Under Medicaid Managed Care"

Over the past decade, there has been a tremendous shift of the Medicaid population into managed care, from less than 10% participating in 1990 to nearly 60% in 2001. This transition has been particularly true for infants who have been primary targets for early inclusion in state managed care experiments. Of the 35% of infants who now qualify for Medicaid services for the duration of their first year, more than half are eligible to participate under a managed care form. These three papers concern infant utilization and retention under Medicaid managed care. I conducted my analyses using Florida Medicaid enrollment and claims files from 1994 to 1999, relying on logistic and linear multi-variate regression methods. During that time, Florida offered two Medicaid managed care options: Primary Care Case Management (PCCM) and Health Maintenance Organizations (HMO).

In my first paper, I found that the shift of infant populations into managed care accomplished many of the access to care goals, if not the cost-savings goals states hoped to achieve. I also found that HMO enrollees and high volume users had higher relative odds of remaining enrolled in Medicaid.

In my second paper, I found that part of the process of enrolling infants into managed care programs may delay their receipt of preventive care. Regardless of whether infants chose or were assigned to a managed care provider, the length of time to provider designation was negatively associated with achievement of preventive care goals.

In my third paper, I found that low birth weight infants were less likely to achieve preventive care goals during their first year and to remain on the Medicaid program after their first year as compared to infants of normal birth weight. Much of this deficit appears due to relatively poor health promotion among mothers of low birth weight infants. In sum, I found that managed care may be a positive innovation for infants enrolled in Medicaid, but that careful consideration should be given to the feasibility of cost savings, to program implementation, and to tracking vulnerable populations, such as low birth weight infants, within the system.


Graduation Year

Dissertation Committee Member