Medicaid is the single largest health insurer for children – providing a comprehensive set of benefits to more than 40 percent of children nationwide and the majority of children with complex medical conditions. Children’s hospitals are major Medicaid providers, and the program is the largest payer of patient care in children’s hospitals.
Children With Medical Complexity
There are 2 million children with complex medical conditions in the U.S. They account for 6 percent of children on Medicaid and 40 percent of Medicaid costs. Under Medicaid, families of children with medical complexity struggle to coordinate their complex, multi-state care. Children's hospitals are advancing federal Medicaid legislation to ease these burdens, improve care and reduce costs by organizing coordinated networks of providers focused on children with medical complexity.
Children's Health Insurance Program
The Children's Health Insurance Program (CHIP) is a joint federal-state program that provides health insurance coverage for low-income children and pregnant women in working families who are not eligible for Medicaid.
Hospitals and health systems are evolving to navigate the changing health care landscape. The notion of an institution that is focused only on admitting, treating and discharging sick patients is fading. Children’s hospitals, by virtue of their expertise, the timing of their interventions early in life, and the reliability of their brand, can potentially impact the health of entire generations.
Private Coverage & Exchanges
Close to half of children have private insurance coverage through their parent(s) employer-sponsored insurance or through the Affordable Care Act’s (ACA) health insurance Exchanges. The ACA includes a number of requirements for private plans that are important for children, including a ban on pre-existing conditions exclusions and lifetime benefit caps; coverage of preventive services, such as immunizations, without cost-sharing; and coverage of key pediatric services, habilitative services and devices, and mental health services.
Access to life-saving specialized medicines is critical for many children. Children’s hospitals depend on the ability to obtain pharmaceuticals in various ways, which includes participation in the federal 340B Drug Discount Program and the usage of group purchasing organizations.
Children’s hospitals may access tools and legal guidance to build and strengthen their issue advocacy capacity, as well as engage their communities on behalf of children before the local, state and federal legislatures.
Speak Now for Kids Campaign
Speak Now for Kids is the association's online advocacy network designed to help raise awareness of the unique challenges which children and families face in our changing health care system.
Graduate Medical Education
Children’s access to care depends on an adequate number of pediatric specialists and subspecialists. The Children’s Hospitals Graduate Medical Education (CHGME) program provides federal funding to freestanding children’s hospitals to support the training of pediatricians and other residents. The future of our pediatric workforce hinges on continuous and adequate funding of this successful program.