Protecting Rights of Children With Medical Complexity in an Era of Spending Reduction

Pediatrics
Jane Perkins, Rishi Agrawal

Abstract

Children with medical complexity (CMC) often require multiple services across the continuum of care, such as therapies and home nursing. However, sufficient access to needed services is not assured and varies considerably by payer, many of whom who face pressures to control health spending. In this article, we review the rights of CMC in Medicaid, the Children's Health Insurance Program, and various forms of private health insurance to receive services that are necessary to promote optimal health, development, and family functioning. Controlling laws such as the Americans with Disabilities Act and the Early and Periodic Screening, Diagnostic, and Treatment provisions of the Medicaid Act are discussed, and precedential court decisions affecting CMC are reviewed. Implications for policy, advocacy, and payment model design are explored in the context of current emphasis on spending reduction.

References

Nov 9, 2011·Archives of Pediatrics & Adolescent Medicine·Dennis Z KuoPatrick H Casey
Dec 2, 2011·Pediatrics·UNKNOWN Committee On Child Health Financing

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Citations

Jul 24, 2020·Hospital Pediatrics·Nancy A MurphyEdward B Clark
May 13, 2021·Inquiry : a Journal of Medical Care Organization, Provision and Financing·Anjani Sheth, Rishi Agrawal
Oct 25, 2021·Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners·Carolyn C FosterMatthew M Davis
Dec 7, 2021·Pediatrics·Justin YuAmy J Houtrow

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