Reforming Medicaid for medically complex children.

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Publication Date



DOI: 10.1542/peds.2013-0252g


Children's hospitals play a central role in our child health care system. These hospitals face unique challenges under health care reform. They care for children with the most complex medical problems but often are not reimbursed for good preventive care, care coordination, or quality. We discuss a proposal by children's hospital leaders to create a network of Nationally Designated Children's Hospitals. These would be Centers of Excellence on which states and families could rely to care for a uniquely vulnerable and uniquely costly population of children. On a federal level, the proposal is focused on 3 provisions: (1) creating and delivering a national coordinated delivery model for children with chronic and complex conditions in Medicaid and the State Child Health Insurance Program; (2) developing pediatric-specific care coordination guidelines, quality metrics, and network adequacy standards to improve pediatric care delivery; and (3) producing cost savings by reducing fragmentation in care delivery, while providing a payment model that provides a significant measure of budget certainty for states and the federal government, either through a bundled payment or a shared savings payment method. We believe that this approach will ensure access to appropriate care without compromising the quality of care. It will also provide enhanced budget certainty for Medicaid and the State Child Health Insurance Program.

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131 Suppl 2

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MeSH Keywords

Cost Savings; Delivery of Health Care, Integrated; Health Care Reform; Hospitals, Pediatric; Medicaid; Models, Organizational; Patient Protection and Affordable Care Act; Practice Guidelines as Topic; United States


State Children's Health Insurance Program; SCHIP; Affordable Care Act; ACA; chronic illness; disabilities; medically complex care; insurance

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