Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #103762

Kimberly A. Thomas, MPH, School of Public Health and Health Services, George Washington University, 1301 15th Street N.W., #812, Washington, DC 20005, 202-518-5847, kathomas@gwu.edu

Pre-school age children undergo physical, cognitive, and social changes that require a range of preventative and tertiary care. The way in which health insurance programs define covered benefits and reimbursement rates influences the types of developmental services afforded children. Objective: The objective of the study was to determine whether there are differences in access to early child development services under the managed care (MC) versus fee-for-service (FFS) delivery systems utilized by the SCHIP and Medicaid programs in Illinois and Maryland. Methods: A policy analysis was conducted using a typology of developmental services developed by Michael Regalado and Neal Halfon. Health insurance provider manuals, managed care contracts, and other publicly-available documents were reviewed to determine covered services. Two case studies were also conducted to highlight the types of services that would theoretically be provided two fictitious children with specific developmental conditions. Results: In the absence of uniform standards of care for early child development services, it is imperative that states clearly articulate the content and periodicity of these services in the regulations for FFS arrangements and in MC contracts. The FFS arrangements in Illinois and to a lesser extent in Maryland provided more comprehensive guidelines about the provision of developmental services. Both states afforded greater flexibility to MC programs to define the scope and frequency of services. By failing to include detailed contractual and regulatory language about early child development services, states may be missing the opportunity to strengthen the link between child development theory and public health insurance administration.

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