New Health Benefit Exchange Must Consider Children with Special Health Care Needs

One of the main accomplishments of health care reform was creating the opportunity to expand health care coverage to the uninsured. The Affordable Care Act contains provisions for states to design Health Care Exchange programs to offer insurance to individuals and families with low or middle incomes.

California emerged as a leader among states and quickly passed enacting legislation just six months after Congress passed the health care reform law. The newly created California Health Benefit Exchange Board has begun meeting to develop benefit packages.

The Lucile Packard Foundation for Children's Health recently wrote to this five-member, appointed board offering to serve as a resource on issues pertaining to children with special health care needs and their families. The Foundation believes it is essential in these early stages of Exchange development to draw the board's attention to the unique challenges and requirements of this population of children. We want to ensure that the benefit packages created by the Exchange provide access to the full array of health care services necessary to provide appropriate care for those with complex conditions. We also want to monitor how these benefits will intersect with other publicly funded health programs, including Medi-Cal, Healthy Families, California Children's Services, and others.

As part of the implementation of the new law, the federal Department of Health and Human Services  (HHS) sets the requirement for the types of benefits that must be included in the Exchanges. At present, HHS has not issued its proposed rule. However, we will encourage California policymakers to offer benefits that will go beyond the basic requirements in the rule, if necessary, to optimize outcomes for these children.

A relatively small proportion of California's children with special health care needs will be covered under the Exchange. However, the creation of new benefit packages offers an opportunity for developing a high quality, cost-effective model to serve these children. In addition, the Exchange has the potential to improve the market to support high-quality health plans and improve benefit packages for children under both public and private plans.

As the board develops its plans, we will continue advocating for inclusion of the particular needs of children with chronic and complex conditions in its deliberations.

We will report on our progress to members of the California Collaborative for Children with Special Health Care Needs. Please take a minute to learn more about our Collaborative and register to be a part of our ongoing advocacy work.

Posted August 10, 2011

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