On Thursday March 22, children’s advocates hosted the second in a four-part series of briefings addressing why Medicaid is essential to children’s health care. The briefing, which was held in collaboration with the bipartisan Congressional Children’s Health Care Caucus, focused on flexibility within the Medicaid program, including waivers and private initiatives. In addition to giving an overview of the waiver process, panelists highlighted various innovations in pediatric patient care and discussed whether they improve quality of care and lower cost for children. The briefing was sponsored by the Children’s Hospital Association, the American Academy of Pediatrics, Family Voices, First Focus, March of Dimes and the Georgetown Center for Children and Families. The panel was moderated by Bob Hall of the American Academy of Pediatrics.
Joan Alker, M.Phil, of the Georgetown Center for Children and Families gave an overview of the types of flexibility that exist within the Medicaid program and spoke about the basics of the Medicaid population. Currently, one out of three children in the United States depend on Medicaid. She also touched on the fact that children with Medicaid have access to quality, affordable care and that the program is viable as a low cost way to provide health insurance coverage to children. Alker also gave a brief background on Section 1115 waivers which provide the broadest waiver authority, allowing states to use federal program funds from Medicaid and the Children’s Health Insurance Program (CHIP) in ways not otherwise permitted, for experimental, pilot or demonstration projects that meet the objectives of the Medicaid program.
The second panelist, Denise M. Rozell, J.D. of Easter Seals, Inc., spoke to the needs of vulnerable populations, specifically children with disabilities, in medical homes and managed care. She explained how some states, like Florida, attempt to lower Medicaid costs by applying a one-size-fits-all approach for children with disabilities. However, as Rozell discussed, this particular population needs unique attention.
“A ‘one size fits all’ approach does not work well for people with disabilities; a personalized approach is necessary for members of vulnerable populations,” said Rozell.
She also discussed the need for sufficient networks of providers, suppliers and community organizations with experience serving these populations before adopting a waiver program.
The Children’s Hospital Association was represented on the panel by Patrick Casey, M.D. of Arkansas Children’s Hospital, who spoke about the hospital’s medical home program as one example of how children’s hospitals are dedicated to being part of the solution to lower Medicaid costs and improve quality of care for children. The program’s enrollment consists of medically complex children followed by at least two subspecialty services with at least two chronic conditions. Casey stated that the program, which began in 2006, now has 466 active patients. In its first year alone, the program saved $3.18 million in Medicaid spending.
“Medical homes for medically complex children are programs that can save Medicaid money while also improving care,” said Casey.
The next presenter, Cindy Pellegrini of the March of Dimes, spoke about the Strong Start initiative launched by Department of Health and Human Services Secretary Kathleen Sebelius on Feb. 8. The initiative aims to reduce costs, improve outcomes, reduce the rate of early elective deliveries prior to 39 weeks gestation and reduce the rate of preterm births for at-risk women and who are covered by Medicaid through testing enhanced prenatal care models.
Olson Huff, M.D. of the American Academy of Pediatrics, the final presenter, spoke to North Carolina’s waiver program, Community Care of North Carolina (CCNC). CCNC has often been hallmarked as the most successful waiver program for the nearly $1.5 billion saved in state and federal spending from 2007 through 2009, achieved largely by reducing hospitalizations and emergency department visits, which has simultaneously improved outcomes for patients. Today, CCNC’s 14 regional non-profit networks of providers, practices, local health departments and community resources serve over 1 million Medicaid recipients across the state, including aged, blind and disabled (ABD) recipients. Huff also spoke to low cost of patients in the program, as spending for program participants in FY 2010 was about 15 percent lower than for others in Medicaid.
The next briefing, scheduled for Thursday May 17, will focus on mental and behavior health initiatives. To access panelist presentations and materials handed out at the briefing, or for more information on upcoming briefings, visit tinyurl.com/medicaidmattersforkids.
