Health Policy Center Authors

Publications by Renee Schwalberg for Health Policy Center

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SCHIP programs appear to be providing broad, affordable coverage to low-income children with special health care needs (CSHCN). A significant number of states have designed special provisions to better meet the needs of CSHCN. The study, based on interviews with government officials, providers, and advocates in 18 states, also found that CSHCN may be disproportionately affected by enrollment waiting periods designed to prevent "crowd out." Waiting periods preclude families from switching their children's private coverage to SCHIP even if that coverage is very limited and/or expensive. The authors suggest changes to permit SCHIP to "wrap around" existing private coverage or exempt CSHCN from waiting period policies.

To gain a more complete understanding of the effects of managed care on service delivery for children with special health care needs (CSHCN), a qualitative evaluation of eight states with different Medicaid managed care models was conducted. Key findings included: mainstream managed care systems, while providing an important locus of organization and accountability for the delivery of primary and specialty medical care, often fell short of being able to identify and serve CSHCN among their enrolled children, to integrate with non-medical systems of care, and to provide intensive case management to support CSHCN; specialty managed care systems, designed specifically to service CSHCN, succeeded more fully in addressing the diverse needs of this population through their unique service delivery and care coordination strategies; and traditional fee-for-service systems offered the least structure and no formal mechanisms for coordinating resources across health, mental health, educational, and other systems of care. (Journal of Health Care Law and Policy 2001; 5(1): 208-232).

This qualitative evaluation studied programs in five states to identify the strengths and weaknesses of alternative models for serving children with special health care needs (CSHCN) under SCHIP. We found that special provisions designed to enhance the coverage and accessibility of services to these children, beyond those extended to children generally, can help to assure that CSHCN enrolled in SCHIP receive comprehensive, coordinated care. (Health Services Research 2000 December; 35(5) Part III: 102-111).

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