Congress mulls bill to improve complex care for pediatric Medicaid patients

Congress will mull legislation that would make it far easier for providers to coordinate the special needs care of pediatric enrollees in the Medicaid program.

StateLine has reported that the bill, known as the Advancing Care for Exceptional Kids Act, has wide bipartisan support and lawmakers will likely debate its merits within the next few weeks.

The bill addresses a problem that is unique to children with special healthcare needs who are enrolled in the Medicaid program. Many of them may have to travel across state lines to hospitals that provide the specialized services that they require. That means that it can be difficult to follow their insurance coverage guidelines once they cross state lines, as what is covered and what is not by Medicaid often varies by state, according to StateLine. Such patients also often face preventable hospitalizations due to a lack of coordination of the care they receive.

These are children with potentially debiliating conditions such as sickle cell anemia, cerebral palsy, cystic fibrosis and congenital heart defects. There are about 3 million children with medically complex conditions in the U.S., but about 2 million are enrolled in Medicaid. And while they comprise just 6 percent of pediatric Medicaid enrollees, the article noted, they represent as much as 40 percent of the program's total costs.

The bill would create networks of care for such children, and direct the U.S. Department of Health and Human Services to encourage hospitals that care for special needs children to enter into regional health information networks in order to better share and coordinate medical data.

The Children's Hospital Association has projected that if passed into law, the bill would save the Medicaid program on the federal and state level as much as $13 billion over 10 years.

Medicaid has come under fire for not evolving fast enough to serve medically complex children. It is already facing other financial issues regarding pediatric care, from potential abuses of the program by dental providers to the lack of genetic testing that would provide more accurate diagnoses of medical conditions. However, the New York Times has reported that providing solid Medicaid coverage for children can boost their future earnings and recoup the costs of the care they received.

To learn more:
- read the StateLine article
- check out the New York Times article
- here's the bill
- here's the Children's Hospital Association report