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Improving the Lives of Young Children

Increasing Referrals and Follow-Up Treatment in Medicaid and CHIP

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Document date: December 30, 2010
Released online: January 28, 2011

Abstract

Many young children have developmental or behavioral problems that could be addressed with appropriate services but are not identified or treated before entering kindergarten, compromising a child's ability to perform up to full potential in school and leading to costly special education and health care interventions later. The patchwork of public programs that finances services creates barriers in access to follow-up services for children identified by diagnostic assessments as having developmental delays or behavioral problems that would benefit from intervention. This brief discusses referrals to services to address developmental delays and behavioral and physical health problems.

The text below is an excerpt from the complete document. Read the entire brief in PDF format.


Executive Summary

Many young children have developmental or behavioral problems that could be addressed with appropriate services but are not identified or treated before entering kindergarten, compromising a child's ability to perform up to his or her potential in school and leading to more costly special education and health care interventions later. The patchwork of public programs that finances services for these children creates barriers in access to follow-up services for children identified by diagnostic assessments as having developmental delays or behavioral problems that would benefit from intervention. For other young children, their healthy development is jeopardized and they and their families lack access to guidance, support, and community services that could improve their opportunities for healthy development. This brief discusses referrals to services to address developmental delays and behavioral and physical health problems. Other resource briefs in this series address screening for developmental delay, case management/care coordination, and two-generational services that affect the health and development of young children.

Despite the fact that Medicaid mandates that enrolled children have access to all necessary treatments and therapies, gaps in service receipt exist for children enrolled in Medicaid. Together, Medicaid and the Children's Health Insurance Program (CHIP) cover half of low-income children and two-thirds of low-income young children. Increasing referral rates and increasing the number of Medicaid- and CHIP-covered at-risk children who receive treatment and intervention services could therefore have a large impact on treatment rates among low-income young children.

This brief discusses the following barriers that limit referral and treatment for children in Medicaid and CHIP:

  • uninsured children identified as needing these services may be eligible for Medicaid and CHIP but not enrolled;
  • reimbursement rates and complex billing rules may make it difficult for providers to serve Medicaid enrollees;
  • primary care providers may not have the capacity to meet the treatment needs of young children within the context of their primary care practice;
  • the lack of medical specialists and community-based treatment providers to provide needed services to children in Medicaid; and
  • the system is fragmented between primary care providers and treatment providers.

These problems undercut the intent of the law that all children should receive medically necessary treatment services.

States can take steps within the existing Medicaid/CHIP policy environment to address gaps. Further, to track gaps and progress in this area, states will need to invest in data systems that allow them to evaluate Medicaid/CHIP participation, screening, assessment, referral, and treatment rates are changing.

End of excerpt. The entire brief is available in PDF format.



Topics/Tags: | Children and Youth | Health/Healthcare


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