income children. Still others believe that it is the responsibility of society to provide medically necessary care for all children regardless of their insurance status.

Broadly speaking, traditional private insurance is primarily designed to provide time-limited coverage for acute episodes, whereas Medicaid also covers treatments which may improve functioning and quality of life, but are not expected to result in a cure. Healthy children, as well as children with special health needs, could benefit from the coordination and management of care that are offered in managed care environments, but some in the children's health community are concerned that managed care does not yet have adequate quality assurance methods for special needs children.

Under the new State Children's Health Insurance Program (SCHIP) legislation, states may choose to expand Medicaid, to create or expand a separate state program for children's health insurance, or to use Medicaid for some uninsured children and a separate program for others. Medicaid expansions must provide the existing Medicaid benefits and must be implemented statewide. Other programs do not need to be statewide but must be based on one of the following three options:

      

    Benchmark coverage. The standard Blue Cross/Blue Shield preferred provider plan for federal employees, or the commercial HMO plan with the largest insured, non-Medicaid enrollment in the state, or a health benefits plan offered and generally available to state employees.

      

    Benchmark-equivalent coverage. This must include hospital services, physician's services, laboratory and X-ray services, well-baby and well-child care, and immunizations. Some coverage of prescription drugs, mental health services, and vision and dental care is required if it is covered under the benchmark plan being used by the state for this purpose.

      

    Another benefits package approved by the Secretary of Health and Human Services.

    As of April 1, 1998, six months after the SCHIP program began, 8 states had federally approved plans that are expected to cover more than 1 million additional children. Another 15 states had submitted plans to DHHS for approval; of these, only 2 states (Connecticut and Massachusetts) had specifically included programs for children with special needs.

    States developing new children's insurance programs have many options for providing coverage for special needs children. The committee encourages states to take advantage of the new program to improve the availability of insurance programs to meet the needs of all children.

    References

    AAHP (American Association of Health Plans). 1997. AAHP Fact Sheets: Chronic Care. Washington, D.C.: AAHP Medical Affairs Department.

    AAP (American Academy of Pediatrics). 1997. Legislative and Regulatory Issue: Maternal and Child Health Block Grant. Washington, D.C.: Author. [http://www.aap.org/advocacy/washing/maternal.htm]

    Alliance for Health Reform. 1997. Managed Care and Vulnerable Americans: Children With Special Health Care Needs. Washington, D.C.: Author.


    Baxter RJ, Mechanic RE. 1997. The Status of Local Health Care Safety Nets. Health Affairs 16(4)7-23.

    Boyle CA, Decoufle P, Yeargin-Allsopp M. 1994. Prevalence and Health Impact of Developmental Disabilities in US Children. Pediatrics 93(3):399-403.


    CMHS (Center for Mental Health Services), Substance Abuse and MentalHealth Services Administration , Department of Health and Human Services (DHHS). 1996. Child, Adolescent, and Family Programs. Washington, D.C.; National Mental Health Services Knowledge Exchange Network.

    Cartland JDC, Yudkowsky M. 1992. Barriers to Pediatric Referral in Managed Care Systems. Pediatrics 89:183-188.

    Carey T et al. 1990. Prepaid versus Fee-for-Service Medicaid Plans: Effects on Preventive Health Care. Journal of Clinical Epidemiology 43:1213-1220.

    Ciotti V, Zodda F. 1996. Selecting Managed Care Information Systems. Health care Financial Management, June, 35-40.


    DHHS (Department of Health and Human Services, Office of the Inspector General). 1996. Children's Dental Services Under Medicaid: Access and Utilization, OEI-09-00240. San Francisco, CA: US DHHS.


    GAO (General Accounting Office). 1997. Medicaid Managed Care Accountability . Washington D.C.: GAO/HEHS/97-86.



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