The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62037

Ana Clark, RN, BSN, PHN, Public Health Programs, Health Net of California, Inc., 11971 Foundation Place, D1, Rancho Cordova, CA 95670, 916-935-1437, Effie.Ruggles@healthnet.com

Health Net, a Managed Care Organization (MCO), under contract with the State of California, has been a major participant in the implementation and operation of Medicaid (Medi-Cal) managed care and SCHIP (Healthy Families) Programs. Medi-Cal and Healthy Families membership includes a significant number of children with special health care needs (CSHCN). Health Net is extensively involved in local, state and national efforts to implement a medical home for all children, especially children with special health care needs.

In Medi-Cal managed care and Healthy Families, the care for certain medical diagnoses in CSHCN is “carved-out” of health plan responsibility to public health programs. The primary care and the creation of a medical home remain the responsibility of the individual child’s primary care provider. Health Net’s involvement in various partnerships has sustained its policy to develop and provide a medical home for all members including CSHCN, where health care services are accessible, family-centered, comprehensive, coordinated and culturally competent.

This presentation will outline how Health Net is involved in local, state and national efforts to address the medical home approach to care for children with special health care needs. The following strategies will be highlighted (1) physician education and training to enhance skills and awareness of CSHCN; (2) dissemination of screening tools to primary care providers and medical groups as instruments to identify CSHCN; (3) promote public/private partnerships to assure coordination of services with carved-out programs for CSHCN; and (4) provision of direct technical assistance to medical groups and IPAs.

Learning Objectives:

• Describe the significant role of the medical home approach for CSHCN in California’s Medicaid managed care and SCHIP programs.
• Identify three stakeholders in the initiative to create medical homes for CSHCN.
• Understand the three critical action steps in the process for the implementation of a medical home for CSHCN.

Keywords: Children With Special Needs, Medicaid Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.