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How do Medicaid/CHIP children with special health care needs differ from those with private insurance?
How do Medicaid/CHIP children with special health care needs differ from those with private insurance?
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Musumeci, MaryBeth, author
Chidambaram, Priya, author - Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body.
- Publication:
- [San Francisco, California] : Henry J. Kaiser Family Foundation, June 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Services
Insurance Coverage
Insurance, Health
Medicaid
United States
State Children's Health Insurance Program (U.S.) - Genre(s):
- Comparative Study
Technical Report - Abstract:
- Medicaid and CHIP cover about half (47%, or about 6.1 million) of children with special health care needs in the U.S. as of 2017 (Figure 1). Box 1 below describes these children. Medicaid or CHIP is the sole source of coverage for 39% of these children. Another 8% have Medicaid/CHIP to supplement private insurance. This issue brief compares the demographics, health status, access to care, and coverage affordability of Medicaid/CHIP children with special health care needs to those with private insurance and those who are uninsured. Medicaid plays a key role for children with special health care needs. It makes coverage affordable by limiting cost-sharing and protecting children from high out-of-pocket costs. Medicaid covers services that private coverage typically does not, including long-term services and supports and Early Periodic Screening Diagnostic and Treatment (ESPDT) services, a comprehensive benefit package of physical and behavioral health services. In addition to covering low income children, states can adopt optional pathways to expand Medicaid coverage for children with significant disabilities. More details about Medicaid's role for children with special health care needs are included in a companion brief. Proposals that would cap and reduce federal Medicaid funding may pose a particular risk to children with special health care needs and their providers. Although efforts to repeal and replace the Affordable Care Act (ACA) and cap federal Medicaid funding through a block grant or per capita cap were narrowly defeated in Congress in 2017, some states, such as Utah and Tennessee, recently passed legislation to seek capped federal Medicaid funding through a Section 1115 waiver. While all of these state proposals may not include children with special health care needs, Tennessee's legislation does include this population. The Centers for Medicare and Medicaid Services reportedly is considering issuing guidance to states on Section 1115 waivers that would cap federal Medicaid financing. A program-wide federal financing cap also is proposed in President Trump's FY 2020 budget. Depending on how they are structured, these policies could have consequences on Medicaid coverage, services, and access to care for children with special health care needs.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (9 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101754881 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101754881