in the community for primary and specialty care, often arranged through university medical centers and correctional health care companies, the latter on a capitated basis.

Community mental health centers and substance abuse treatment facilities offer specialized care to women and sometimes to children. Drug treatment is funded primarily through the Substance Abuse, Prevention, and Treatment Block Grant. States receiving this funding are required to set aside a minimum of 5% of the funds for treatment of pregnant women, and to give pregnant women priority in enrolling for treatment services. States are also required to provide primary care, prenatal care, and child care to the women served under the set-aside. In common with prison system, substance abuse treatment facilities often contract with community providers for primary and specialty health care services.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers food supplements, nutritional counseling, and referrals to maternity and child health care for pregnant women and children at approximately 10,000 sites, often at locations where they receive other care.

Many public and nonprofit providers receive funding to provide specific HIV- and AIDS-related care to women and children. In addition, there is a network of facilities to provide such care exclusively. These include HIV testing and counseling centers, community-based nonprofit AIDS service organizations, and clinic settings.

Financing Health Care Services For Women, Children, And Adolescents

Health care for women of reproductive age and for children is financed by private and public insurance and by a wide range of other funding mechanisms that support community-based public and not-for-profit agencies. The number of Americans who do not have health insurance coverage continues to grow. Nearly 41 million persons under age 65 were without public or private health insurance in 1996. Approximately 19% of women of childbearing age (18–34 years) and 10% of children under 18 are uninsured (Kaiser Commission on Medicaid and Uninsured, 1998a). There are a number of reasons for this growth in the uninsured, not the least of which is the cost of coverage for the employer, the employee, and the individual purchaser.

The number of persons without health insurance coverage puts a strain on public and private, nonprofit community-level agencies that offer health care. If the patient has health insurance, these agencies receive reimbursement from the insurer, including Medicaid. If the patient does not have insurance, these agencies must cover patient care through grants and contracts and/or other types of support from multiple federal, state, and local sources, both public and private, including philanthropy.



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