Virginia L. Miller, DrPH, Center for Healthcare Effectiveness Research, Wayne State University School of Medicine, RM 121 Shiffman Medical Library, 4325 Brush Street, Detroit, MI 48201, 313.993.1332, vmiller@med.wayne.edu, Angela Martin, MSW, Developmental Disabilities Institute, Wayne State University, 268 Leonard Simons Building, 4809 Woodward Avenue, Detroit, MI 48202, and David R. Moss, JD, Law School, Wayne State University, 471 West Ferry Mall, Detroit, MI 48201.

The Human Genome Project has created an explosion of new knowledge about the function of human genes with resulting increases in the number of genetic tests available. The increased availability of genetic tests raises concerns for all families, especially for families who have children with genetic-related disabilities. The purpose of our study was to learn what policies and practices heath maintenance organizations (HMOs) have regarding services and testing for individuals with genetic related disabilities. Michigan is an ideal setting as Medicaid managed care has been in place for several years and the population is ethnically diverse. Using a case scenario format, a survey instrument was designed with input from a multidisciplinary team to conduct interviews with benefits specialists in HMOs throughout southeastern Michigan. Twenty-seven (27) HMOs were identified to participate in the structured interview. Among the HMOs interviewed to date (11), the responses related to coverage for durable medical equipment (DME) highlight that compelling physician documentation is warranted to obtain coverage of DME of a higher standard, for example, electric wheelchair versus manual. Among the completed interviews, four HMOs did not address the children’s issues as families with children with disabilities were referred to the Children with Special Health Care Needs Program. Our findings underscore the need for families to navigate through a complex system of documenting needs and service authorizations.

Learning Objectives:

1.Program participants will develop an understanding of the public health implications of the Human Genome Project as it relates to families who have children with disabilities
• Program participants will gain an overview of the complex health care insurance issues for families who have children with disabilities
• Program particpants will identify key issues related to the practices and policies of health maintenance organizations related to services for individuals with disabilities

Keywords: Children With Special Needs, Health Insurance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.