Connecting Care for Children and Families: Testing New Approaches to Improve Outcomes and Manage Costs

Children covered by Medicaid and the Children’s Health Insurance Program (CHIP) often rely on care delivered across separate health, behavioral health, and community systems that were not built to work together. Families can face repeated handoffs, delayed support, and unmet needs as they navigate services on their own.

For the Centers for Medicare & Medicaid Services (CMS), this creates both a quality and cost challenge. Delayed care, unmet needs, and poor coordination can contribute to avoidable emergency department use, disruptions in care, and higher long-term Medicaid expenditures.

CMS launched the Integrated Care for Kids (InCK) Model in January 2020 through the Center for Medicare and Medicaid Innovation to test whether new service delivery and payment models can improve outcomes for children while reducing or maintaining Medicaid costs. The model focuses on children and youth ages 0–20 enrolled in Medicaid, with some award recipients also serving pregnant and postpartum beneficiaries.

The InCK Model is designed as a child-centered, local delivery and payment model. Award recipients use administrative data and screening-based assessments to identify Medicaid-enrolled children with health and health-related needs. Children with greater needs are eligible to receive more intensive integrated care coordination or case management services.

Over its implementation period (2022-2026), the model aims to improve quality of care, reduce out-of-home placements, and reduce or maintain Medicaid expenditures by strengthening service integration, investing in local partnerships, and supporting earlier intervention. 

WHAT WE'RE DOING

Using rigorous evaluation to understand how integrated care models perform in practice.

CMS contracted with Abt and partners Bailit Health and Westat to evaluate implementation and impact across the seven InCK award recipients operating in six states. Abt is leading a mixed-methods evaluation that combines quantitative analysis with qualitative insight from providers, frontline staff, caregivers, and beneficiaries. The evaluation is designed to answer four central questions:

• How award recipients implemented the model
• How the model affected children and families
• Whether disruptions in care or services affected outcomes
• How results vary across communities and implementation approaches 

Abt designed a quasi-experimental impact analysis to compare outcomes between attributed beneficiaries and comparison groups across participating communities.

This approach helps CMS move beyond implementation tracking alone. It provides evidence on whether early identification, service integration, and alternative payment models improve care quality, utilization, family experience, and total cost of care.

The evaluation reflects Abt’s long-standing approach to evidence generation: pairing rigorous analysis with practical insight that supports federal decision-making.   

IMPACT

Early findings show progress in care coordination, with important lessons for future model design.

Abt’s third evaluation report covers the first two years of implementation, from 2022 through 2023. Findings show that award recipients successfully launched core elements of the model, though implementation depth and beneficiary engagement varied significantly across award recipients.

All award recipients implemented approaches to needs assessment and Service Integration Level stratification. They also launched InCK-specific Alternative Payment Models (APMs), though payment implementation timelines differed by award recipients.

Some APMs focused on addressing longstanding system gaps by supporting care coordination services. Others aimed to encourage higher-value care and stronger coordination across providers.

The evaluation found other important patterns:

Prevention and early identification.

• Administrative data helped streamline screening and identify high-needs children more efficiently than labor-intensive outreach alone.
• Award recipients expanded outreach efforts to increase participation and engagement.
• Care coordinators frequently addressed urgent family needs tied to food, housing, and other non-medical drivers that affect health outcomes and care access.

Beneficiary engagement remained limited.

• Despite implementation progress, overall engagement levels remained low in many award recipients during the first two years. The percentage of attributed beneficiaries engaged in the model ranged from 0.1% to 12.6% by the end of 2023.
• Limited engagement reduced the ability to detect broader population-level impacts during the early model period.

Outcome findings were promising in some award recipients, but overall findings for quality improvement and cost reduction were mixed.

Implementation delays limited the number of award recipients for which the evaluation could test model impacts:

• North Carolina InCK increased well-child visits by 2.9% compared with its comparison group.
• Illinois Village InCK slowed growth in total cost of care, generating relative savings of 4.8%.
• Emergency department visits findings were inconclusive.

As the model continues through 2026, the evaluation will track whether greater engagement and provider participation lead to measurable improvements in care quality, service use, and costs.

The InCK Model evaluation gives CMS practical evidence about how pediatric integrated care models function in real-world settings for children covered by Medicaid or CHIP. The findings show that strong model concepts alone are not enough. Success also depends on operational realities: data-sharing capacity, provider participation, feasible screening methods, and payment structures that support coordinated care.

The evaluation results reinforce  the importance of prevention and early intervention. Coordinated care can help families address needs before they escalate into more serious health or social challenges.

For children and caregivers, stronger coordination can mean:

• Fewer gaps between services
• Earlier support for behavioral and physical health needs
• Better navigation across systems
• Clearer care plans and more stable support

For CMS, the evaluation results can help determine which approaches can scale and which need refinement before broader adoption.

The InCK Model continues through December 2026. Abt will assess implementation, beneficiary engagement, provider participation, quality measures, utilization, and cost trends to assess whether the model can achieve sustained population-level impact. By turning complex data into clear evidence for action, Abt helps CMS build stronger Medicaid and CHIP programs that improve care coordination, support healthier outcomes, and create a more effective system for children and families.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Project

Evaluation of the Integrated Care for Kids Model

Client

U.S. Centers for Medicare & Medicaid Services