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APHA Scientific Session and Event Listing

Recorded presentation

Ian T. Hill, MPA, MSW, Health Policy Center, The Urban Institute, 2100 M Street, NW, Washington, DC 20037, 202/261-5374, ihill@ui.urban.org

In February 2006, Congress passed the Deficit Reduction Act of 2005 (DRA), which contained several cuts to the Medicaid program. One notable provision granted states flexibility to replace the traditional Medicaid benefits package with less comprehensive “benchmark” coverage for certain groups. As under the State Children's Health Insurance Program (SCHIP), “benchmark” coverage could include benefits equal to a state's employee health benefit plan, among others. Child advocates are particularly concerned about the implications of this provision for children, for whom Medicaid's Early and Periodic Screening, Diagnosis, and Treatment provisions have long guaranteed coverage of any services deemed medically necessary.

This paper explores the implications of DRA for children and examines whether lessons from SCHIP may be applied to Medicaid so that children continue to receive the services they need. Based on findings from the Urban Institute's SCHIP Evaluations, several innovative state models hold promise for application to Medicaid. For example, both Connecticut and Florida designed their Husky Plus and Children's Medical Services programs to provide EPSDT-equivalent “wrap around” benefits for SCHIP enrollees with special health care needs. Such models embrace several principals that hold promise to protect vulnerable children on Medicaid, including: systematic screening of all children to identify special needs; coverage of preventive care according to the content and periodicity endorsed by the American Academy of Pediatrics; wrap-around benefits that include unlimited specialty, behavioral, rehabilitative and other services; and a definition of medical necessity that allows for coverage of services to maintain, and not just improve or restore, functioning.

Learning Objectives: