Complete Children’s Health

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Complete Children’s Health! Get Complete Health Care for Your Children

The Congress is currently negotiating reauthorization for the State complete children’s health insurance program. It faces several contentious issues including formula allocations, funding levels, enrollment requirements, and eligibility. The SCHIP benefit structure, which includes cost-sharing and covered benefits, was a major issue in 1997’s initial authorization. However, it has been relatively neglected in the current debate.

Many parties, including conservative think tank and insurance industry players, have made proposals that could have a significant effect on the benefits that low-income children might receive.

Two of their suggestions should lead to a reconsideration on how Medicaid, SCHIP, and private coverage benefit plans meet low-income beaumont behavioral health children’s health care needs in different degrees. One, that SCHIP reauthorization funds should be used to fund tax credits and other financing mechanisms; and two, that the state SCHIP programs should focus more on enrolling children into private or employer-based coverage.

Benefit Design for Reauthorization and SCHIP

  • The American Academy of Pediatrics regularly updates its recommendations regarding journey mental health benefits. These AAP recommendations are applicable to all children. They do not apply to children with low incomes. However, they can be used as a guideline for determining whether children should be covered under public or private insurance. The AAP recommends medical care, critical care and pediatric surgery, as well as behavioral health services, special services for children with special requirements, and pediatric dental health.
  • These recommendations are comprehensive and reflect the important role that health services play in a child’s life. This includes lifelong skills like speech and physical activity, as well as enhanced school performance due to improved hearing and vision. These recommendations do not address benefits limits which are part of both private and public coverage. They also affect complete children’s health access and use to services across all income levels. They also do not address cost-sharing plans for these services. Significant deductibles and copayments could affect children with lower incomes’ access to benefits.
  • Professors Sara Rosenbaum from George Washington University and Dr. Paul H. Wise at Stanford University noted that while private insurance products may offer limited coverage terms, they “seek” to avoid financing the wide range of developmental conditions children might experience. The case law cited by the authors shows that private coverage is designed to exclude coverage for chronic and developmental conditions. Plan administrators have broad discretion in approving or denying coverage. Rosenbaum and Wise note also that private coverage does not cover certain services due to service setting, diagnosis, or other “hard” limitations.
  • A few surveys on health care provide information about employer-based coverage for specific benefits. This includes prescription drugs and behavioral health. It may be of interest to adolescents and children. These surveys also showed that, while most workers and their dependents have access to these services, the vast majority of enrollees are subject to significant limitations.

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