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Child Physical & Behavioral Health
Children and families should receive the physical and behavioral health services they need in order to thrive and become, or remain, healthy and successful members of society. Lack of access to health care can contribute to school failure, suicide, criminal behavior, unwanted pregnancy and other expensive problems which present a growing challenge for Ohio’s child welfare and juvenile justice systems.
Access to health care should not be determined by an individual’s age, race, gender, religion, disability, or ability to pay. If made a priority by Ohio’s leaders, Ohio can afford to support and care for the health and well-being of its citizens.
Behavioral HealthMental health is essential to overall health. In order to be and to stay healthy, children and their families need to be able to access behavioral health services when needed—early and preventively.
Our recommendations:- Build upon the successful Access to Better Care (ABC) initiative by increasing funding for prevention, early intervention and treatment for behavioral health services for children, youth and families by at least 10% in each year of the 2008-2009 state budget. ABC is a major initiative enacted in the 2006-2007 state budget in response to the growing realization that shortchanging kids with alcohol, drug and/or mental health services needs results in increased costs in other parts of the system, primarily child welfare and juvenile justice.
- Increase funding for voluntary screening and when needed, diagnosis and treatment, of behavioral health in young children ages 0-6.
- Strengthen programs to address youth suicide prevention. Approximately 23% of all Ohio high school students report having considered suicide and it is estimated that nearly 64,000 Ohio youth ages 15-19 attempt suicide each year. Twenty-four thousand will require medical treatment after the attempt and 151 will actually kill themselves.*
*Data gathered from Ohio Department of Mental Health
Children With Special Health Care NeedsAn estimated 384,500, or 13.9% of Ohio children, have special health care needs.* These children and their families need support to develop to their maximum potential.
Our recommendations:- Invest in and strengthen programs that assist families in caring for their children’s special health care needs in their homes. These long term care services provide support that relieves family stress and keeps families intact. Families should not have to endure financial hardship or the decision to institutionalize a child when a proven program exists.
How to achieve this: Increase the availability of Home and Community Based Services (HCBS) for children. This includes increases in the Ohio Home Care Waiver administered by ODJFS and the Individual Options and Level 1 waivers administered by the Ohio Department of Mental Retardation and Developmental Disabilities. HCBS waivers offer a home care alternative to institutional care.
As of July 1, 2006, 1039 Ohioans (of all ages) are on the waiting list for the Ohio Home Care waiver. Over 17,000 (of all ages) are on the waiting list for waivers for people with mental retardation and developmental disabilities.
- Ensure on-going services and support for children served by the Bureau for Children with Medical Handicaps (BCMH). BCMH provides financial aid and care management to eligible families with children with medical handicaps who incur high health care costs. The Legislative Committee on the Future Funding of BCMH is charged with providing recommendations for how to sustain the program in the future including the 2008-2009 budget. Ohio should ensure that the needs of this population will continue to be addressed and that funding will not be reduced.
* 2001 National Survey of Children with Special Health Care Needs
Child and Family Physical HealthHealth insurance is a key variable in the equation of how children and families access health care. Medicaid is a critical component of health coverage for Ohioans and in any given month, approximately 30% of Ohio’s children are covered by Medicaid.
Ohio should build on the success of Medicaid for children and families, by:- Maintaining Medicaid coverage for children at 200% of the federal poverty level (FPL) ($33,200 annually for a family of three), with the current benefits package and EPSDT guarantee (Early Periodic Screening Diagnosis and Treatment program).
- Maximizing the impact of the EPSDT program so that children covered by Medicaid receive the mandated developmental exams and medically necessary services for physical and behavioral health.
- Maintaining the current policy of no cost-sharing for children, pregnant women and other exempt populations, and prohibit cost-sharing for all on Medicaid with incomes under 100% of the Federal Poverty Level ($16,600 annually for a family of three). Any cost-sharing above 100% of FPL should be minimal in order to prevent barriers to enrolling or seeking needed care.
- Support and fund efforts to find and enroll more of the estimated 93,500 uninsured Ohio children who are eligible for, but not enrolled in, Medicaid, including allowing presumptive eligibility for children. Strengthen systems and practices to retain people on Medicaid once they are enrolled by simplifying the re-enrollment process and establishing a 12-month renewal period for adults (like most children already have).
Ohio should help low-income working parents by:- Restoring Medicaid eligibility for parents from 90% of FPL to 100% FPL ($16,600 annually for a family of three).
- Providing health coverage for uninsured adults between 100 – 200% of FPL through a blend of private insurance and Medicaid. This can be done by using a model to provide affordable coverage options to small employers and self-employed persons as well as premium assistance to help those below 200% FPL pay their premium share.
Ohio should give more babies a healthy start in life by:- Expanding Medicaid coverage for pregnant women from 150% FPL to 200% FPL.
- Pursuing a federal waiver to provide pre-pregnancy health services to parents of childbearing age to ensure healthy pregnancies and healthy babies.
- Broadening the understanding of Fetal Alcohol Spectrum Disorder and strengthening prevention and intervention.
U.S. Variations in Child Health
This report examines variations among states' child health care systems, building on the State Scorecard published by The Commonwealth Fund Commission on a High Performance Health System. Focusing on 13 performance indicators of access, quality, costs, equity, and the potential to lead healthy lives, the authors find wide variation among states, including distinct regional patterns. Across states, better access to care is closely associated with better quality of care. Top-performing states, such as Iowa and Vermont, have adopted policies to expand children's access to care and improve the quality of care. While leading states outperform lagging states on multiple indicators, all states have opportunities to improve. National leadership and collaboration across public and private sectors are essential for coherent, strategic reforms to improve child health care in the United States.
Updates on New Health Expansions for 2008
As part of Voices for Ohio’s Children’s health policy campaign, we are actively involved in federal advocacy for children’s health coverage. Here is a current overview of the rapidly changing children’s health policy federal landscape:
State Children’s Health Insurance Program Funding- The State Children’s Health Insurance Program (SCHIP) has been reauthorized by Congress until March 2009. The reauthorization comes with the guarantee that all state program shortfalls will be covered. Although this is not the full five-year reauthorization passed by Congress but vetoed by the President, it does provide needed short-term funding for Ohio and other states.
- We anticipate that full SCHIP reauthorization will be reconsidered in 2009.
State Children’s Health Insurance Program Eligibility- On December 20, 2007, the federal Centers for Medicare and Medicaid Services (CMS) denied Ohio’s State Plan Amendment to extend Medicaid coverage to children living in families with incomes from 200%-300% of the federal poverty level (FPL). However, we understand that Ohio will shortly file a state plan amendment to extend Medicaid/SCHIP coverage to children living in families with incomes from 200%-250%. Wisconsin has gained CMS approval for a Medicaid/SCHIP expansion to 250% FPL; Louisiana has applied but has not yet received approval for Medicaid/SCHIP expansion to 250% FPL. We anticipate approval of Ohio’s state plan amendment, but there are no guarantees nor is there an estimated timeframe for how quickly a decision would be made.
- Even as we seek to maximize Ohio’s SCHIP coverage under existing Centers for Medicare and Medicaid Services guidelines, we are working with other statewide and national advocates to advance federal legislation that would override the existing guidelines and allow Ohio to implement its full proposed Medicaid/SCHIP expansion for children living in families up to 300% FPL. Federal advocacy to achieve this goal is a top priority in 2008 for Voices and Ohio Covering Kids and Families.
- Administration leaders are assessing what options Ohio has to cover children living in families from 250%-300% with state funds rather than through SCHIP or Medicaid. This option would require an increase in state funding, but could allow coverage for some children in this income category while other federal solutions are explored. Gov. Strickland’s January 23, 2008 announcement about projected state deficits in the current biennium will likely make this option difficult to achieve.
Coverage for Already-Eligible Children
Even in the midst of changing federal policy, we must remember that an estimated 106,000 uninsured Ohio children living in families up to 200% FPL are already eligible for our state’s existing health coverage programs. Sadly, with a projected economic downturn threatening Ohio’s working families, this number may increase. Even in the midst of our advocacy to expand eligibility, we are committed to vigorous outreach and enrollment efforts that will help more already-eligible children receive coverage.
Estimates of Enrollment and Uninsured Ohioans
Legislative Briefing on Medicaid Expansions
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