ORIGINAL RESEARCH article
Front. Allergy
Sec. Asthma
Parent-identified Opportunities for Improving Asthma Care for Children Insured by Medicaid Following Implementation of a Statewide Medicaid Accountable Care Organizations in Massachusetts
Provisionally accepted
Sarah Goff1*
Charlotte Faye Gilson1
Sai S. Chilakapati1Joyce Mogaka1
Berry L. Williams1
Erin DeCou1Kimberley H. Geissler2- 1University of Massachusetts Amherst School of Public Health & Health Sciences, Amherst, United States
- 2University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, United States
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Abstract Background Childhood asthma is common and associated with extensive racial, ethnic and socioeconomic healthcare inequities and health disparities. Approximately 50% of children with asthma are insured by Medicaid in the U.S. and states have increasingly implemented Accountable Care Organization (ACO) models in their Medicaid programs, but little is known about the effects of ACOs on pediatric asthma quality of care, utilization, and disparities. Seventeen new ACOs were implemented in Massachusetts in 2018. Delivery System Reform Incentive Payments were provided to ACOs that could be used to improve outcomes for chronic diseases,, such as asthma, through quality measures, enhanced care coordination, and community health worker staffing. This qualitative study explored caregiver experiences with pediatric asthma care for their Medicaid-insured child following ACO implementation in Massachusetts. Methods Semi-structured virtual interviews were conducted with caregivers of Medicaid-insured children with asthma in Massachusetts between July 1-December 31, 2023. Purposive sampling aimed to include a range of participant and practice characteristics. The overarching theoretical framework was an adaptation of the Framework of Asthma Disparities, and data were analyzed using rapid qualitative analytic methods. Results Of the 26 participants, 96% were female; 23% identified as Black and 39% as Hispanic. Key themes included: 1) Perceived lack of changes in asthma care related to Medicaid ACO implementation; 2) Insurance coverage influences on asthma care; 3) Perceptions of asthma management in primary care; 4) Perceptions of asthma specialist care; 5) Influence of health
Keywords: pediatric, Primary Care, Asthma, Qualitative, Medicaid, ACO, Health Care Reform
Received: 29 Aug 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Goff, Gilson, Chilakapati, Mogaka, Williams, DeCou and Geissler. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sarah Goff, sgoff@umass.edu
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