Many families and health advocates are worried about the transition of nearly 860,000 children from California’s Healthy Families SCHIP program to the state’s Medicaid program, Medi-Cal – and with good reason.
Although Medi-Cal in theory offers distinct benefits for children with special health needs (CSHCN), those benefits are compromised by low reimbursement rates for providers and a dearth of pediatric specialists willing to accept Medi-Cal patients. Yet the transition, which started Jan. 1, 2013, already is underway.
Our new Issue Brief, Children with Special Health Care Needs and California’s Healthy Families Transition to Medi-Cal, outlines some of the promises and pitfalls that lie ahead for families of children with special health care needs, and offers recommendations for a smoother transition.
Here are our recommendations for California state health officials:
- Have plans to address the most likely potential problems of the transition, and should be prepared to promptly implement those plans should it be necessary, such as slowing the phases of the transition, and implementing a process to ensure continuity of care for children whose health depends on established relationships with health care providers.
- Plan for the transition of CSHCN and monitor system problems in real time. There will be an increased need for out-of-plan subspecialty care, transportation, and an expansion of the available health information technology to facilitate access and continuity during the transition.
- Contract for a publicly reported evaluation of the transition after the first six and 12 months of the process. The evaluation should analyze changes in costs to the state, interruptions in continuity of care, access to primary and specialty care and patient satisfaction, particularly assessing the experience of families of CSHCN.
To read the Issue Brief, click here.