Issues in Developing Programs for Uninsured Children: A Resource Book for States. G. Coordination of Care for Children With Special Health Care Needs With the Maternal and Child Health Bureau

03/02/1998

Three of the nine states reported comprehensive efforts to coordinate the care of children with special health care needs with the state health departments’ Maternal and Child Health (MCH) programs. Since state Maternal and Child Health programs have traditionally been responsible for the care of special needs children, there has been concern about the enrollment of these children into programs that may contract with managed care plans. To ensure access to comprehensive care, the state MCH programs have interacted with families and managed care plans to provide "wrap around" services, coordinate care, and provide transportation. MCH programs have also focused on continuing the provision of other services not generally covered by managed care but provided through Title V programs. For example, children who become severely ill may require services covered under the MCH program for children with chronic illnesses. Therefore, MCH may coordinate with the separate state program to ensure such children receive the appropriate care. In two instances, Healthy Kids has utilized the Maternal and Child Health program as a reinsurer for children with chronic conditions not covered by Healthy Kids.

  • In Tennessee, ninety percent of children with special health care needs are enrolled in TennCare. There are currently eleven managed care organizations participating in TennCare. Therefore, the Maternal and Child Health program has focused a substantial amount of effort on negotiating the appropriate care for children with special needs with the contracted plans. In cases where children are denied services, families of those children appeal to the health plan, and if denied again, the Maternal and Child Health program will often provide the services through the Children’s Special Services (CSS) program. This most often occurs with the provision of medical devices.
  • In Washington, the State is beginning to enroll SSI-eligible children in managed care through the Basic Health Plus program. There is a substantial amount of coordination occurring between the Children with Special Needs Department and Medicaid as they seek to determine the best way to provide care for this population.