Policymakers need to consider the unique needs of children when making decisions on the scope, structure, and plan participation of the Exchanges. Key issues to consider include:
Continuity of Care
Continuous coverage, particularly for children with special health care needs, must be ensured even when a child’s provider leaves a health plan’s network.
Coordination with Medicaid/CHIP
There should also be strong coordination between the enrollment and health care delivery systems used by the Exchange and Medicaid/CHIP to promote continuity of care.
Essential community providers
Health plans should be required to contract with all essential community providers, including children’s hospitals where available, that serve low-income and medically-underserved populations.
Essential health benefits
It is critical that the essential benefits package include pediatric-appropriate services, including not only preventive and primary care services, but also the specialty services required by many children with special health care needs.
Exchange governing boards and stakeholder/advisory groups should include an individual who has experience with the utilization of pediatric health care.
Network adequacy standards must ensure that children have reasonable access to the providers they need.
Exchange plans should be required to provide adequate payments for all providers.
Exchange plans should be required to report on national pediatric specific quality measures using a common set of measures for children so that the quality of pediatric care in the exchanges can be assessed.
The full issue brief is attached.