Behavioral health programs are those services and supports that address the mental, behavioral, emotional, and substance use needs of CYSHCN.
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 helps ensure CYSHCN receive all needed services and avoids duplication. At its best, care coordination is a covered service.
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 is federally mandated benefit, for all children 0 to 21 enrolled in Medicaid.
Title V programs, Medicaid agencies, and Family Leader organizations have a variety of programs that help families raising CYSHCN understand health care financing.
Children and youth in foster care are an often overlooked subpopulation of CYSHCN with unmet health care needs.
Race, ethnicity, language spoken at home, culture, number of functional difficulties, and socioeconomic factors affect access to health care and coverage for CYSHCN.
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 address underinsurance by requiring private health insurers to cover specific benefits, such as such as early intervention, autism services, or medical foods.
Medicaid buy-in programs create a pathway to Medicaid for CYSHCN with complex health needs whose family income is too high for Medicaid.
States may request a waiver from the Centers for Medicare and Medicaid Services to cover other groups of individuals by “waiving” certain federal regulations.
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 help pay the extraordinary expenses that can overwhelm a family’s budget when a child has complex health care needs.
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 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 are the services and supports that help youth with special health care needs move from pediatric to adult systems of care.