Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

Sandra Tanenbaum, Brian Hilligoss, Paula Song

Research output: Contribution to journalArticle


This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.

Original languageEnglish (US)
Pages (from-to)3-20
Number of pages18
JournalJournal of Children and Poverty
Issue number1
Publication statusPublished - Jan 2 2019



  • accountable care organizations (ACOs)
  • caregiving
  • Children with disabilities
  • medicaid
  • poverty

ASJC Scopus subject areas

  • Demography
  • Education
  • Sociology and Political Science
  • Urban Studies

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