RESUMO
PURPOSE: To examine implementation issues and challenges affecting access to care for adolescents during the first year of SCHIP operation in five states (California, Connecticut, Maryland, Missouri, and Utah). METHODS: Information was obtained through on-site interviews with senior SCHIP program staff members, medical directors, and other key staff members from managed care organizations; key staff members from behavioral health subcontractors or the state's behavioral health plans; a variety of physical and mental health providers; and families. Analysis of relevant SCHIP documents and available enrollment, capitation, and quality data was also conducted. RESULTS: The five states generally have focused little attention in the start-up phase to the unique service needs of adolescents. Although primary care was readily available, concerns were raised about training and experience in serving this population and the availability of multidisciplinary practice arrangements. Access to family planning did not appear to be a problem. However, access to mental health services and dental services was seriously affected by limited provider participants. CONCLUSIONS: Because adolescents constitute a sizeable proportion of the SCHIP population, states and managed care organizations need to consider ways to increase the participants of adolescent providers and to identify various financial and other incentives to address the serious shortages in mental health services and dental care.
Assuntos
Serviços de Saúde do Adolescente/economia , Ajuda a Famílias com Filhos Dependentes/economia , Acessibilidade aos Serviços de Saúde/economia , Medicaid/economia , Planos Governamentais de Saúde/economia , Adolescente , Serviços de Saúde do Adolescente/organização & administração , California , Connecticut , Assistência Odontológica/organização & administração , Prescrições de Medicamentos/economia , Serviços de Planejamento Familiar/organização & administração , Humanos , Entrevistas como Assunto , Maryland , Serviços de Saúde Mental/organização & administração , Missouri , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Estados Unidos , UtahRESUMO
Many young children with permanent hearing loss do not receive hearing aids and related professional services, in part because of public and private financing limitations. In 2006 the Children's Audiology Financing Workgroup was convened by the National Center for Hearing Assessment and Management to evaluate and make recommendations about public and private financing of hearing aids and related professional services for 0- to 3-year-old children. The workgroup recommended 4 possible strategies for ensuring that all infants and young children with hearing loss have access to appropriate hearing aids and professional services: (1) clarify that the definition of assistive technology, which is a required service under Part C of the Individuals With Disabilities Education Act (IDEA), includes not only analog hearing aids but also digital hearing aids with appropriate features as needed by young children with hearing loss; (2) clarify for both state Medicaid and Children's Health Insurance Programs that digital hearing aids are almost always the medically necessary type of hearing aid required for infants and young children and should be covered under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program; (3) encourage the passage of private health insurance legislative mandates to require coverage of appropriate digital hearing aids and related professional services for infants and young children; and (4) establish hearing-aid loaner programs in every state. The costs of providing hearing aids to all 0- to 3-year old children in the United States are estimated here.