The Impact of Medicaid Managed Care on Health Service Utilization Among Adults With Intellectual and Developmental Disabilities.

Kiyoshi and team tracked what happened when adults with intellectual or developmental disabilities switched to Medicaid managed care. They used old claims and new claims to compare the same people before and after the switch.

The study looked at ER trips, nights in the hospital, and regular doctor visits. All data came from state Medicaid files, so no one had to fill out surveys.

After the switch, ER visits dropped a lot. Most of the drop came from mental-health ER trips and non-urgent visits. Hospital stays and primary care visits also went down.

In short, the new plan cut how often adults with IDD used almost every kind of care.

Koegel et al. (2014) saw that adults with IDD already used the ER less than other adults for dental pain. Kiyoshi now shows managed care slashes ER use even more, but for all reasons. The two papers do not fight each other—one looked at dental-only ER trips, the other at every kind.

Mammarella et al. (2022) proved that a quick behavioral training lets almost half of adults with IDD get a dental exam without sedation. That study shows we can cut some ER visits by teaching skills instead of changing insurance.

Capio et al. (2013) also used Medicaid data and found adults with Down syndrome spend more on care when they still see kids’ doctors. Like Kiyoshi, it shows service use changes fast when the system changes.

Maine et al. (2020) reviewed 16 health-promotion programs for young adults with IDD. Most ran in gyms or schools and tried to boost exercise. The review says evidence is thin, so real-world drops seen by Kiyoshi may outshine small pilot gains.

If your state is moving to managed care, expect sharp drops in visits—both needed and unneeded. Track which clients stop seeing primary care or psychiatry. Build referral bridges now so ER cuts do not turn into health gaps later.