Financing Strategies

Financing Strategies

Many Title V and Medicaid programs use funds from their own programs or leverage other funding to reduce the number of Children and Youth with Special Health Care Needs (CYSHCN) without health insurance, close benefit gaps, pay for additional services, and build the capacity of the system of care. This page links to examples of the innovative strategies states are using to improve and finance care for CYSHCN.

Behavioral Health

Behavioral health programs are those services and supports that address the mental, behavioral, emotional, and substance use needs of CYSHCN.

Benefits Counseling

Some Title V programs and family leader organizations provide benefits counseling to help families understand the full range of health insurance benefits and any additional coverage options available in their state.

Care Coordination

Care coordination helps ensure CYSHCN receive all needed services and avoids duplication. At its best, care coordination is a covered service.

CHIP

The Children’s Health Insurance Program (CHIP) is a public benefits program exclusively for uninsured children whose family income is too high for Medicaid.

EPSDT

EPSDT is federally mandated benefit, for all children 0 to 21 enrolled in Medicaid.

Family Supports

Title V programs, Medicaid agencies, and Family Leader organizations have a variety of programs that help families raising CYSHCN understand health care financing.

Foster Care

Children and youth in foster care are an often overlooked subpopulation of CYSHCN with unmet health care needs.

Inequities

Race, ethnicity, language spoken at home, culture, number of functional difficulties, and socioeconomic factors affect access to health care and coverage for CYSHCN.

Managed Care

Many states contract with private health insurers to manage, provide or arrange for the provision of care, and coordinate care for Medicaid enrollees.

Mandated Benefits

Mandated benefits address underinsurance by requiring private health insurers to cover specific benefits, such as such as early intervention, autism services, or medical foods.

Medicaid Buy-ins

Medicaid buy-in programs create a pathway to Medicaid for CYSHCN with complex health needs whose family income is too high for Medicaid.

Medicaid Waivers

States may request a waiver from the Centers for Medicare and Medicaid Services to cover other groups of individuals by “waiving” certain federal regulations.

Premium Assistance

In premium assistance programs, a state agency pays all or part of a family’s health insurance premiums. These programs are often implemented for low-income working families.

Relief Funds

Relief funds help pay the extraordinary expenses that can overwhelm a family’s budget when a child has complex health care needs.

TEFRA

TEFRA gives states the option to provide Medicaid coverage to children with severe disabilities who require an institutional level of care, regardless of family income.

Telemedicine

Telemedicine is a capacity-building service that is of particular benefit in geographic areas where pediatric sub-specialty care is unavailable or difficult to access.

Transition Services

Transition services are the services and supports that help youth with special health care needs move from pediatric to adult systems of care.