What Is a Usual Source of Care? Medical Homes and Continuity of Care in Mississippi Medicaid (pt 1 of 3) When someone talks about having a medical home for all children in the United States or, even more specifically, for children in Mississippi on Medicaid, what does he or she mean? In the broad sense, the American Academy of Pediatrics has adopted a very formal definition of a medical home (MH) where care must be available in the child’s community, continuous, comprehensive, coordinated by the medical home, family centered, compassionate, and culturally effective. 1 In Mississippi, not all of these seven characteristics can be evaluated for children on Medicaid by using Medicaid administrative claims data. The main purpose of this brief is to define how we will measure a usual (or regular) source of care as part of the medical home concept by using Medicaid administrative claims data available through the Mississippi Division of Medicaid (MS-DOM). 2 According to MS-DOM, a medical home in the Mississippi Medicaid Medical Home (MMMH) program is defined “...as the usual and customary source that provides both preventive and treatment or diagnosis of a specific illness, symptom, complaint, or injury” and serves “as the focal point for a beneficiary’s health care, providing care that is accessible, accountable, comprehensive, integrated, and patient centered..” 3 The MMMH program began in February 2005 by extending coverage for annual physical examinations to adults, while children (up to age 21) were already covered by the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, which is a mandatory service provided under Medicaid. The program administrators stated that “the option of a free yearly physical will save more Medicaid dollars by eliminating unnecessary emergency room visits and diagnosing many medical problems before they become serious conditions.” 4 This series of three policy briefs will establish baseline measures for testing this type of claim for children from birth up to 18 years. Although MS-DOM considers children to include all those eligible for Medicaid from birth up to 21 years, we examine data for children from birth up to 18 years for two principal reasons: 1) all Medicaid eligibles 18 years and older were subject to a co- payment for physical examinations until February 2005; 3 and 2) many legal rights and responsibilities for persons 18 and older end for their caretakers when children become legal adults at age 18. By using Mississippi Medicaid administrative claims data, the idea of the “medical home” as a place or as a provider will be measured by how we define a usual source of care (hereafter referred to as USOC). For this brief, we have analyzed these data for State Fiscal Years (SFY) 2002 and 2003, separately, for general questions at the state level concerning: •The percentages of those with: 1) at least one health care visit and at least three- fourths of their visits to the same health care provider (USOC); 2) at least one health care visit and less than three-fourths of their visits to the same provider (No USOC); and 3) no health care visits during the 12- month period from birth through 17 years overall. Grouped together, the clients in these three categories are referred to as eligibles (persons who have met the criteria to qualify for Medicaid 5 ). The total number of eligibles with at least one visit is the number of beneficiaries for a SFY (i.e., eligibles are potential beneficiaries, but to be a beneficiary 6 the eligible must have had at least one visit to a place or provider); The Mississippi Health Policy Research Center is a division of the Social Science Research Center at Mississippi State University. HEALTH POLICY BRIEF May 2007 Carol R Campbell Jeralynn S Cossman Jarryl B Ritchie