Kay Johnson

Kay Johnson has been a leader in child health policy for 25 years. She is a Research Assistant Professor of Pediatrics at Dartmouth Medical School and a Lecturer in Health Policy at the George Washington University. She also is president of Johnson Group Consulting.

With passage of CHIPRA, federal policymakers may be tempted to think they need not worry about children as they discuss health reform.  Yet the truth is that any major health reform legislation will have an impact on children’s coverage and ultimately on their health. Whether health reform proposals are aimed at the employer market, intended to create a new public plan, or to make adaptations to Medicaid, children will be affected in substantial and important ways.  As Congress and the Obama Administration work to provide coverage for more Americans, they should also pay attention to children.

For children under age 21, health plans should be required provide an appropriate child-specific benefit package.  Such a package would reflect the unique needs of children and be designed to support the optimal development of children.  It should include coverage for prevention, diagnostic, and treatment services to promote the physical, mental, behavioral, and oral health of children and to correct or ameliorate defects, illnesses, or other medical conditions.  Preventive services should fit the American Academy of Pediatrics Bright Futures guidelines, particularly since the Task Force on Clinical Preventive Services list of evidence-based practices does not include many child-relevant services.

The old adage “children are not little adults” is particularly true in terms of health care.  Compared to adults, for example, children need distinct content in preventive “well-child” visits, require different prescription drugs or medications delivered in different dosages, and present with more opportunities to prevent disability and chronic disease.  Their brains, bodies, teeth, and all are growing and developing.  Moreover, children who have serious illness or other special health care needs have better outcomes when they are cared for by pediatric medical specialists and are covered by child-appropriate benefit packages.  Appropriate, evidence-based children’s health benefit packages are, of necessity, different from those of adults.

For example, one critical aspect of child development is hearing and
speech.  Infants and toddlers need to hear sound in order to learn to
speak.  With newborn screening and prompt intervention, infants and
toddlers hearing impairments have the best chance to learn language
(whether by voice or by sign).  We know this and other similar early
intervention is effective and cost-effective.

The children’s benefit package in Medicaid, known as Early, Periodic, Screening, Diagnosis and Treatment (EPSDT),
was designed as a comprehensive set of child-specific benefits. For
more than 30 years, the program has been guided by pediatric standards
of care.  Federal regulations require state Medicaid programs to use a
“preventive and ameliorative” medical necessity coverage standard for
children.  Coverage is to be sufficient to prevent, correct, or
ameliorate a child’s health condition.

This high standard of
coverage, which is child-specific, and designed to support the optimal
development of children, is unique to the Medicaid program.  Unlike the
EPSDT benefit in Medicaid, benefit packages offered to individuals with
employer-sponsored coverage are designed to adults primarily.  Some
have appropriate coverage for dependent children (see the National Business Group on Health model plan), but this is the exception not the rule.  This includes many plans purchased under CHIP.

While
the nation has made substantial progress toward assuring coverage for
all children, health reform brings an opportunity to assure that the
benefit packages for children give access to appropriate services.
There is strong evidence to support the need for a child-specific
benefit package.  Benefits should cover the screening, diagnosis, and
treatment services children need.  Without a national benefit standard,
states are unlikely to design child-specific benefit packages, which
emphasize early and preventive care and ensure coverage for a
comprehensive set of developmental, physical, mental and dental
services.  Here’s hoping Congress can see the value in guaranteeing our
children not just coverage, but the right coverage to promote their
healthy growth and development.

The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.