["Health Services Research, Volume 61, Issue 4, August 2026. ", "\nABSTRACT\n\nObjective\nTo describe factors influencing caregiver engagement in pediatric care management.\n\n\nStudy Setting and Design\nThis qualitative descriptive study of family engagement was based in the North Carolina Integrated Care for Kids (NC InCK) care management model. NC InCK proactively offers assistance with healthcare coordination and health‐related social needs to Medicaid‐insured children in five North Carolina counties. Participants were randomly recruited from three cohorts with different levels of engagement (never engaged, briefly engaged, and retained) and participated in semi‐structured virtual interviews to understand barriers and facilitators to both enrollment and retention in care management. Cross‐cohort themes were identified using rapid qualitative analysis.\n\n\nData Sources and Analytic Sample\nInterviews were conducted between May 2024 and January 2025 with 50 NC InCK‐eligible English‐speaking families.\n\n\nPrincipal Findings\nMost participants were mothers (n = 38, 74%) and grandmothers (n = 6, 12%) of non‐Hispanic Black children (n = 32, 64%). Initial enrollment facilitators included clear, genuine explanations of care management tailored to family needs. Enrollment obstacles included high caregiver self‐reliance, confusion around program scope, and negative prior experiences with social service programs. Retention facilitators included flexible scheduling, convenient communication, and strong interpersonal relationships with care managers. Retention obstacles included competing demands, communication challenges, evolution of family needs, and misalignment between caregiver expectations and services. Post‐interview, 32% of briefly engaged and 73% of never engaged participants requested re‐enrollment in the NC InCK model.\n\n\nConclusions\nCare management is a fundamental pediatric population health strategy, but low family engagement limits large‐scale implementation and impact. Strategies to increase participation include clear messaging and simplified eligibility criteria to effectively convey care management benefits. Strong care manager communication skills are needed to build relationships with caregivers from varied backgrounds. Evolving family needs and bandwidth necessitate flexible care management options rather than a one‐size‐fits‐all model.\n\n"]