Financing Care for CYSHCN in the Next Decade: Reducing Burden, Advancing Equity, and Transforming Systems

Area of Science:

• Health Services Research
• Health Policy
• Pediatric Healthcare

Background:

• Children and youth with special health care needs (CYSHCN) face significant barriers in accessing and affording necessary services.
• Existing healthcare financing policies often exacerbate challenges related to provider access, continuous coverage, and benefit adequacy.
• Racial disparities and societal risks further complicate the healthcare landscape for CYSHCN and their families.

Purpose of the Study:

• To outline principles and strategies for establishing a robust system of care for CYSHCN and their families.
• To identify and address barriers within healthcare financing that impact CYSHCN.
• To propose recommendations for improving the financing of services for CYSHCN.

Main Methods:

• Analysis of the "Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families" document.
• Identification of financing-related barriers faced by families of CYSHCN.
• Formulation of recommendations for policy and practice changes.

Main Results:

• Healthcare financing structures present challenges in provider network adequacy, service continuity, and benefit comprehensiveness for CYSHCN.
• Potential innovations include state Medicaid expansion, enhanced transparency in medical necessity determinations, and improved reimbursement rates.
• A coordinated approach involving federal and state agencies, providers, and families is crucial for successful implementation.

Conclusions:

• Achieving a system of care that prioritizes the wellbeing of CYSHCN and their families necessitates significant improvements in healthcare financing.
• Policy innovations and a commitment to value-based assessment are essential for overcoming existing financial hurdles.
• Collaborative efforts are key to ensuring accessible, affordable, comprehensive, and continuous care for CYSHCN.