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| Publications | ||
| Children with Special Health Care Needs |
Reports: A 50-State Analysis of Medicaid Benefit Coverage for Children without EPSDT. Memorandum to the March of Dimes and National Association of Children's Hospitals, September 2005. This memorandum provides an analysis of the Medicaid coverage that would be available to children in each state if the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit requirement was eliminated and states applied the coverage policies in effect for categorically needy adults. It examines 12 benefits of particular importance to children with chronic physical and developmental conditions, including physician services, inpatient hospital services, outpatient hospital services, prescription drugs, physical therapy, occupational therapy, speech therapy, home health services, private duty nursing, personal care services, durable medical equipment, and medical supplies. Detailed state tables are included. Information is based on state plans and state plan amendments, current as of April 2005. Findings show that absent EPSDT, all children with chronic or disabling conditions, but especially those residing in Southern states, could face exclusions or restrictions in coverage for specialized therapeutic services. Download a free pdf of this report.
Eligibility, Benefits, and Cost-sharing in Separate SCHIP
Programs State SCHIP Requirements and Innovations for Children with
Special Health Care Needs Program Cuts Affecting Half of All State Title V Programs for Children with Special Health Care Needs by Margaret A. McManus, Harriette B. Fox and Stephanie Etienne, Fact Sheet No. 2, 4 pages, March 2002, $10.00. This fact sheet examines state Title V CSHCN program changes resulting from state budget shortfalls in fiscal year 2002. States reported on reductions in administrative spending, enrollment, eligible conditions and services, and planned program expansions. The findings are based on a brief survey of Title V CSHCN program directors conducted in December of 2001 and January of 2002. Download a free pdf of this report. The Strengths and Weaknesses of Private Health Insurance Coverage for Children with Special Health Care Needs by Harriette B. Fox, Margaret A. McManus, and Mary B. Reichman. Report, 62 pages, January 2002, $55.00. This report presents findings from a detailed analysis of private health insurance benefits for services important to children with special health care needs. The report examines the extent of plan coverage available for services required by six hypothetical children with different chronic conditions: asthma, attention deficit hyperactivity disorder, cerebral palsy, major depressive disorder with attempted suicide, spina bifida, and substance abuse with bipolar disorder. The analysis considers the availability of the benefit, access restrictions or protections relevant to the child´s particular condition, and limits in amount and duration of coverage. The report also provides a review of plan coverage policies for 22 medical, behavioral health, and specialized health services. Detailed tables on benefit limits and coverage requirements as well as cost-sharing provisions are included. Information for the study was obtained from contract documents for the most commonly sold HMO and PPO products in each state. Download a free pdf of this report. Pediatric Provider Capacity for Children with Special Health Care Needs: Results from a National Survey of State Title V Directors by Stephanie J. Limb, Margaret A. McManus, and Harriette B. Fox. Report, 50 pages, March 2001, $30.00. This report summarizes the results of a national survey of state Title V directors of programs for children with special health care needs on access to pediatric providers. It addresses Title V directors´ assessments of access to medical homes; pediatric medical and surgical subspecialty care; inpatient hospital care; home health care; occupational, physical, and speech therapies and audiology services; dental care; and mental health care. It also includes an analysis of the most significant causes of access difficulties. Innovative strategies and recommendations to address pediatric provider problems are highlighted. Included in the report are detailed tables documenting each state´s rating of access to the specified services and their assessment of the most important causes of access difficulties. Download a free pdf of this report. Access to Care for S-CHIP Children with Special Health Needs by Harriette B. Fox, Margaret A. McManus, and Stephanie J. Limb. Report, 64 pages, December 2000. Available from the Kaiser Family Foundation (1-800-656-4533; package code 2226). This report presents findings from a five-state study of S-CHIP implementation issues and challenges affecting access to care by children with complex physical, developmental, behavioral, and emotional conditions. The report examines access to pediatric specialty and mental health networks; access to covered services, including mental health treatment and prescription drugs; and the operation of two states´ wrap-around benefit programs for children with special needs. Also examined are cost-sharing requirements, plan selection, and the use of health risk assessments. The report provides detailed tables on enrollment, benefits, and cost-sharing requirements as well as a description of each state´s program. Information was obtained primarily through on-site interviews with S-CHIP officials, manage care organization officials, providers, and families. Download a free pdf of this report. An Analysis of Safeguards for Children with Special Needs in States´ Medicaid Managed Care Contracts, 1999 by Harriette B. Fox, Margaret A. McManus, and Jonathan S. Austrian. Issue Brief No. 4, 24 pages, December 2000, $30.00. This issue brief provides an analysis of the extent to which the 34 states that mandatorily enrolled BBA special-needs child groups into managed care organizations at the end of 1999 used contract requirements consistent with HCFA´s interim review criteria. The brief includes background on the 34 states´ mandatory enrollment policies for each of the five BBA groups as well as an examination of their definitions for and methods of identifying these children; contract requirements concerning treatment plans, case management, and coordination; contract requirements concerning provider network capacity and access; and state policies governing quality assurance and payment protections. This analysis was based on telephone interviews with state Medicaid officials and an examination of state managed care contract documents. Pediatric Provider Networks for Children with Special Needs in the Current Health Insurance Market: Report from an Expert Work Group by Margaret A. McManus, Harriette B. Fox and Paul W. Newacheck. Report, 25 pages, November 2000, $35.00. This report summarizes the major barriers experienced by pediatricians serving children with special health care needs in managed care arrangements. It includes a comprehensive literature review on pediatrician satisfaction with managed care. A set of recommendations to address these problems is also included. Download a free pdf of this report. An Analysis of States´ CHIP Policies Affecting Children with Special Health Care Needs by Harriette B. Fox, Regina R. Graham, Margaret A.McManus, and Christine Y. Chen. Issue Brief No. 5, 62 pages, April 1999, $40.00. This issue brief examines how S-CHIP plans, approved as of January 31, 1999, were structured with respect to eligibility, benefits, plan arrangements, and cost-sharing policies to serve children who have special health care needs. The report includes detailed state tables on each of these topics and includes information on carve-out policies, quality assurance requirements, and insurance arrangements. Information for the report was obtained through an extensive analysis of the 48 approved S-CHIP applications, including state responses to HCFA´s questions and conditions; all S-CHIP contract documents constituting the managed care contract with insurers; and interviews of S-CHIP program directors. Download a free pdf of this report. A Compendium of Federally Funded Projects on Managed Care and Children with Special Health Care Needs by the MCH Policy Research Center. 40 pages, February 1998, $20.00. This compendium of federally funded projects on managed care and children with special health care needs provides a summary of over 50 projects funded in nine areas: definition and identification of children with special health care needs, pediatric-risk adjusted capitation methods, quality of care, family participation, provider network capacity, special managed care program demonstrations and evaluations, coordination of general managed care and behavioral health plans, and integration of public program services with managed care. For each topic there is also a discussion of background findings and gaps in knowledge. Evaluating Managed Care Plans for Children with Special Health Care Needs: A Purchaser´s Tool by Margaret A. McManus. University of Florida at Gainesville, 7 pages, 1998. Available online from Institute for Child Health Policy. This evaluation tool, presented as a brochure, is intended to assist purchasers of health insurance for children in assessing the capacity of plans to cover necessary pediatric services, make appropriate providers available, and assure quality. It provides information relevant to coverage of children with and without chronic conditions. Available online from Institute for Child Health Policy.
Medicaid Managed Care for Children with Chronic or Disabling Conditions: Improved Strategies for States and Plans by Harriette B. Fox and Margaret A. McManus. Report, 67 pages, July 1996, $40.00. This report presents findings and recommendations from an extensive study of Medicaid managed care arrangements for children with developmental, emotional, behavioral, or complex physical conditions. The report describes the range of chronic conditions and disabilities among children, provides a snapshot of current Medicaid managed care policies and plan practices affecting children, and presents a discussion of alternative structural arrangements that states might use in serving these children through managed care. It also identifies essential components of state managed care contracting policies and plan practices. Information for the report was obtained through an extensive literature review and interviews with plans, state Medicaid agency staff, pediatric providers, and families. Expert advice was also obtained through an advisory group and key informant interviews. Impacts of State Medicaid Demonstration Waiver Programs on Children: Results From Hawaii, Oregon, Rhode Island, and Tennessee by Harriette B. Fox and Margaret A. McManus, Report, 100 pages, March 1996, $40.00. This report presents findings from an examination of four state Section 1115 Medicaid demonstration waiver programs to assess their impacts on children. The report addresses each program´s impact on uninsurance among children, the extent to which the enrollment process facilitated appropriate plan placement, the adequacy of plans´ pediatric provider networks and coordination mechanisms, the appropriateness of service coverage and authorization policies, the sensitivity of quality assurance measures for children, and the impact on publicly funded programs that traditionally serve children with special health needs. Information for the report was obtained primarily through on-site interviews with key officials, providers, families, and plan medical directors in the four states. Children with Special Health Care Needs in Managed Care Organizations: Definitions and Identification, Family Participation, Capitation and Risk Adjustment, and Quality of Care by the Division of Services for Children with Special Needs of the Maternal and Child Health Bureau. 39 pages, 1996, $20.00. This report is a summary of expert work group meetings on four topics related to managed care: identification of children with special needs, family participation, capitation and risk adjustment, and quality of care. For each topic, the discussion includes a problem statement, examples of current research and innovative approaches, and recommended activities. Using Medicaid to Finance Care Coordination Services for Children and Adolescents with Severe Emotional Disorders by Harriette B. Fox and Lori B. Wicks, Technical Report, 80 pages, 1991, $25.00. This report identifies the ways in which Medicaid can be used to finance care coordination services furnished to children and adolescents with severe emotional disorders. It presents information about basic Medicaid program requirements that pertain to coverage of care coordination services, describes six options for Medicaid financing of various care coordination activities, and assesses the pros and cons of each option with regard to youth having severe emotional disorders. The report also describes five model care coordination systems and indicates the extent to which Medicaid could be used to finance each one. Medicaid Financing for Mental Health and Substance Abuse Treatment Services for Children and Adolescents by Harriette B. Fox, Lori B. Wicks, Margaret A. McManus, and Rebecca W. Kelly, Technical Report, 69 pages, May 1990, $25.00. This report provides an assessment of the ways in which the Medicaid program can be used to finance many components of treatment for children and adolescents with mental health or substance abuse problems. The report provides an overview of the state role in developing Medicaid eligibility and service benefit provisions, provides detailed information on Medicaid coverage policies in each state, and discusses opportunities for covering mental health and substance abuse treatment services under the various Medicaid benefit categories.
Access to Health Care for Children with Special Health
Care Needs.
Improving State Medicaid Contracts and Plan Practices for
Children with Special Needs
A New Definition of Children with Special Health Care Needs An Epidemiologic Profile of Children with Special Health
Care Needs Medicaid Managed Care Policies Affecting Children with
Disabilities: 1995 and 1996 Children with Chronic and Disabling Conditions
Enhancing Preventive and Primary Care for Children with
Chronic or Disabling Conditions Served in Health Maintenance Organizations
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