Discussion of the topic of children with special health care needs
and managed care needs to include some information for physicians and
administrators regarding the fact that under Medicaid, Federal law already
defines certain groups of children as "children with special health care
needs" by virtue of their membership in certain publicly-funded service
populations. You do not need to establish a prospective health problem in
order to screen and assess these children, and since foster children, one
of the groups so defined, are generally seeking care related to their
prior history of maltreatment, time is of the essence in getting them
screened adequately to assure the best treatment outcome.
This problem should not have to be resolved by local advocacy, county
by county across all the states, which is what is happening now. It
should be a "given" element of the system of care: these kids already
qualify for comprehensive screening and assessment services, including
behavioral health assessment services, before you even see them for the
first time.
This is important because it is the screening and case-finding
function which is most lacking, largely because many states have not
informed managed care providers, public and private, that services to
these groups of children should be based on the assumption that they need
(at least) thorough, timely assessment - - whether or not the "magic
words" deemed to establish medical necessity for a course of treatment are
pronounced by the social services case manager on behalf of these children
in attempting access services through the mental health services case
managers' access/entry system.
Children receiving Title IV-E services, that is, public child welfare
or foster care services, are one of the most prominent groups defined by
Federal statute as children with special health care needs. There are
several other groups, in addition.
These children are categorically defined as children with special
health care needs on a group or “categorical” basis, without regard to
whether any individual child has an identified specific special health
care need at any particular time.
The availability, timeliness, and appropriateness of care for these
children with regard to mental health services has already been the
subject of various studies at the state and national levels which have
found wide-spread, serious problems in accessing care for these children,
some of whom are probation wards in addition to the larger group who are
the subject of child protective services intervention for maltreatment.
Children removed from the home because of parental neglect or
maltreatment have already experienced conditions which would adversely
affect almost any child, and often for a long period before actual removal
from their parents. The poor behavioral outcomes for children in foster
care are not only the result of shortcomings in the foster care system or
the poor genetics of their parents. They result also from serious
inadequacies in the publicly-financed health care system where they should
be receiving effective treatment for the effects of parental maltreatment
and adversity.
Your article does not mention that medical and behavioral health
providers need be alert to these priority service populations whether or
not any one child they may see comes into care with an identified specific
health need or condition. Federal Medicaid law already clearly
establishes the presumption that any child in these categories needs
timely and complete assessment and treatment whether the particular state
Medicaid agency access regulations OR a specific managed care contract
specifically says so.
I refer you to the excellent reports by UCLA School of Public Health
<http://www.healthychild.ucla.edu/Publications/ChildrenFosterCare/Documents/Mental%20health%20brief%20final%20for%20distribution.pdf>
and by the General Accounting Office on this subject, at
<http://www.gao.gov/docsearch/abstract.php?rptno=GAO-01-749> and
related reports
HEHS-00-169 "Medicaid Managed Care: States' Safeguards for Children
With Special Needs Vary" <http://www.gao.gov/new.items/he00169.pdf>
and
HEHS-00-37 "Medicaid Managed Care: Challenges in Implementing
Safeguards for Children With Special Health Care Needs"
<http://www.gao.gov/new.items/he00037.pdf>)
and to the superb resources on contracting for publicly-funded
managed care services at Georgetown University's School of Public Health -
Center for Health Services Research and Policy - at
<http://www.gwhealthpolicy.org/chsrp/>
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