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

Abstract #119457

Anne R. Markus, JD, PhD, MHS¹, Sara Rosenbaum, JD², Alexis Crumbley, JD¹, Alexandra Stewart, JD¹, and Marisa Cox, MA¹. (1) Department of Health Policy, The George Washington University Medical Center, 2021 K St, NW, Suite 800, Washington, DC 20006, 202-530-2339, armarkus@gwu.edu, (2) Center for Health Services Research and Policy, The George Washington University, 2021 K St, NW Suite 800, Washington, DC 20006

Overview: Medicaid and SCHIP agencies play important roles in ensuring that children have access to quality care. Not only are they federally required to improve quality, but as the largest purchasers of health care for low-income children, they possess the leverage needed to align coverage and payment policies to encourage adherence to professionally acceptable standards of care. Research Objective and Design: The primary research objective is to examine state coverage and payment policies of child health services. Researchers used systematic documentary review to examine all 50 Medicaid and 35 separate SCHIP coverage and payment policies. A series of reviews of coverage policy have been conducted. Preliminary findings: (1) Medicaid and SCHIP coverage differ in measurable ways, even when designed to work in a parallel. (2) Medicaid fee-for-service programs are more specific in coverage policy than Medicaid managed care programs. (3) Medicaid programs are more specific than SCHIP programs in both their coverage and payment policies. Conclusions: Preliminary findings suggest that a discrepancy exists between state promises of comprehensive preventive pediatric coverage and the services states actually reimburse. A lack of standardization makes it difficult for families and their advocates to understand coverage policies. Finally, they suggest that managed care may present a particular challenge in conveying coverage and payment expectations to plans and network providers.

Learning Objectives:

• - Examine state coverage and payment policies of child health services.
• - Review results from study all 50 Medicaid and 35 separate SCHIP coverage and payment policies.
• - Discuss conclusions from a series of related studies.

Keywords: Children's Health, Health Insurance

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.