• CYSHCN account for 80% of pediatric health care expenditures
  
  
• Annual cost of providing medical care to CYSHCN:
  Hospitalization: 61%
  Specialists: 14%
  Durable medical equipment: 5%
  Primary care: 5%
  Other: 15% ¹
  
  
Financial burden of childhood disability
• "...continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome expenses. Additional efforts are needed to protect these high-risk children and their families." ²

Financial Implications for the Medical Home

• Medical homes are not free - if we are serious about ensuring that every CYSHCN has access to a medical home, then payment must be found for services not typically covered by insurance, such as care coordination, transition planning and family supports.


• Medical homes link children and families with ancillary and support services, but these services need to exist and be financed.³

Teaching Tools
cme.kff.org/Key=8773.DRB.C.C.JgCmB3
To mark the 40th anniversary of the creation of Medicare and Medicaid, new video documentaries produced by the Kaiser Family Foundation explore the history, politics and impact of Medicare and Medicaid and include perspectives from people involved in the original 1965 debate and implementation of our nation's major health financing programs. The documentaries can be viewed online or ordered on DVD.

AAP Medicaid Reimbursement Report for Commonly Used Pediatric Services, 2004/05
www.aap.org/research/medreimPDF0405/Medicaid_Reimbursement_2004-05_Interim_Report.pdf

Key Resource
Catalyst Center: Financing Care for CYSHCN and Medical Homes
www.hdwg.org/projects/catalyst.htm
The Catalyst Center seeks to promote adequate financing for comprehensive, family-centered care of children and youth with special health care needs. The Center works with a broad range of stakeholders in financing and coverage issues including government agencies, parent groups, health and social service agencies, employers, payers and other stakeholders to determine family and community needs, identify gaps in current funding to meet those needs, and develop creative funding strategies. The Catalyst Center is managed by an interdisciplinary team with guidance from a diverse national advisory committee.

The goal of the Catalyst Center is to improve the financing of care for children and youth with special health care needs. This includes:
• Expanding health insurance coverage of CYSHCN across the country;
• Closing the financing gaps faced by underinsured families across the country;
• Developing strategies to pay for services that CYSHCN need but that insurance does not typically cover
• Developing and disseminating innovative financing strategies at community, state and national levels;
• Ensuring high levels of knowledge and collaboration related to financing among key stakeholder groups in all states and territories.
  
  
Role of the Catalyst Center
• Work with medical home initiatives to define the components of medical home that need financial support
• Work with medical home initiatives to develop staffing ratios and cost estimates
• Identify models for paying for medical home – comprehensive strategies and incremental strategies
• Develop financing briefs and case studies for medical home financing
• Promote enhanced communication and problem solving among stakeholders to address financing issues
  
  Activities and Resources
• Centralized web site for the dissemination of financing information
• National Advisory Committee of diverse stakeholders to provide direction, identify innovative financing strategies, and assist with dissemination
• Research bureau to research new financing topics identified by stakeholders
• Intensive technical assistance to Catalyst states and their collaborators
• Participate in meetings/conferences with other National Centers to disseminate financing strategies for medical home
• Produce technical assistance materials for families, states, payers, providers and employers.

Web sites / Organizations
American Academy of Pediatrics (AAP): www.aap.org

AAP Committee on Child Health Financing
www.aap.org/visit/cochf.htm
The Committee on Child Health Financing monitors and makes policy recommendations to the Board of Directors on various aspects and sources for financing health care for children, both private and public, and in all modes of delivery. The Committee also develops resources and information services on managed care for pediatricians. It also collaborates with other Committees in informing chapters of federal and state financing activities to assist chapters in their efforts to influence the monies involved in state determination of Medicaid, MCH, and other government, or private, health care financing programs. The AAP has created fact sheets that explain the importance of the Medicaid program, and how children in every state rely on it for their health care. Please click here to see the Medicaid fact sheet for your state.

AAP Department of Practice and Research
www.aap.org/visit/pedpract.htm
The Department of Practice and Research fulfills the informational needs of the AAP by providing facts on pediatric practice and physician payment systems, and developing original research. The Division of Health Care Finance and Practice is one of four divisions within the department. It provides analysis and program support for AAP committees and sections that address the financing, organization, management, and delivery of pediatric care.

AAP Child Health Topics:
www.aap.org/topics.html
Browse through health topics such as: Behavioral and Mental Health, Community Health, Diseases and Conditions, Family Health, Healthy Development, Navigating the Health Care System, Populations with Unique Health Care Needs. Direct link to Financing information from the AAP: www.aap.org/healthtopics/access.cfm

AAP State Government Affairs Information:
www.aap.org/advocacy/sgalinks.htm
Provides helpful information on State Access to Children's Health Insurance, Medicaid and waivers, contracts, statistics, and surveys is listed on this Academy Web page. The AAP has also created fact sheets that explain the importance of the Medicaid program, and how children in every state rely on it for their health care. Please click here to see the Medicaid fact sheet for your state.

Center for Health Care Strategies: www.chcs.org/
The Center for Health Care Strategies promotes high quality health care services for low-income populations and people with chronic illnesses and disabilities. CACHES achieves this objective through training, technical assistance, and grant making to state purchasers of publicly financed health care, health plans, and consumer groups. Its program priorities are: improving quality, reducing racial and ethnic disparities, and increasing community options for people with disabilities.

Centers for Medicare & Medicaid Services: http://cms.hhs.gov/
CMS is the Centers for Medicare & Medicaid Services. Formerly known as the Health Care Financing Administration (HCFA), they are the federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children's Health Insurance), HIPAA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs.

The Commonwealth Fund: www.cmwf.org/
The Commonwealth Fund is a private foundation that supports independent research on health and social issues and makes grants to improve health care practice and policy. The Fund is dedicated to helping people become more informed about their health care, and improving care for vulnerable populations such as children, elderly people, low-income families, minority Americans, and the uninsured. The Fund’s two national program areas are improving health insurance coverage and access to care and improving the quality of health care services.

The Health Assistance Partnership from Families USA:
www.healthassistancepartnership.org/
HAP addresses the needs of the nation's consumer health assistance programs that help people with health insurance problems. The Partnership provides assistance and resources in the areas of: Medicaid (including the Medicaid and SCHIP Eligibility Manual), Medicare (including the Medicare-Approved Drug Discount Card Resource Center),
Private Insurance, and The Uninsured Weekly Email Alert: Learn

The Kaiser Family Foundation's State Health Facts Online:
www.statehealthfacts.kff.org/
Contains the latest state-level data on demographics, health, and health policy, including health coverage, access, financing, and state legislation.

KaiserEDU offers tutorials that are multimedia presentations on health policy issues, research methodology or the workings of government. Topics include: Uninsured, Medicare, Medicaid, Prescriptions Drugs, Health Systems
www.kaiseredu.org/tutorials_index.asp

The National Center on Financing for CSHCN: cshcnfinance.ichp.ufl.edu/
This Web site will be used to disseminate information generated from the project. In addition, the site has linkages to various sites of relevance to this project. These sites include the institutions and organizations participating as partners in the project as well as sites with general information about financing and reimbursement strategies in health care.

National Health Law Program: www.healthlaw.org
The National Health Law Program is a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities. NHeLP serves legal services programs, community-based organizations, the private bar, providers and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people.

Rand Health: www.rand.org/health/
Rand Health is a research division within the Rand Corporation and the first
organization to be called a "think tank." RAND has been working to improve policy
and decision making through research and analysis. RAND Health focuses on advancing understanding of health and health behaviors, and examining how the organization and financing of care affect costs, quality, and access.

1. Health Partners/Institute for Health and Disability, 1997
2. Newacheck PW, Inkelas M, and Kim WE. Health Services Use and Health Care Expenditures for Children With Disabilities. Pediatrics 2004;114: 79-85
3. Catalyst Center

Last Updated March 8, 2007