Increasing Referrals and Follow-Up Treatment in Medicaid and CHIP

Young children who have developmental or behavioral problems are sometimes not identified or treated before entering kindergarten. According to a research brief by the Urban Institute, the public programs that finance services for these young children can present obstacles that interfere with their care.

Medicaid requires that enrolled children have access to all necessary treatments, but gaps in services remain for enrolled children. Together, Medicaid and the Children’s Health Insurance Program cover two-thirds of low-income children. The brief identifies several significant barriers that limit treatment for children in Medicaid and Chip. Convoluted reimbursement rates and billing rules can prevent providers from serving Medicaid enrollees, or providers may not have the capacity to treat these young children within the context of their primary care practices. Additionally, the system is fragmented between primary care providers and treatment providers. The brief also notes that uninsured children who qualify for services and treatment may be eligible for Medicaid, but not enrolled.

States cand address gaps in services by reducing paperwork and contracting with organizations that are designed to serve children with complex needs, according to the brief. The brief also recommends that states invest in data systems to better track Medicaid and CHIP participation.

The brief was published in December 2010 by the Urban Institute.
 

Read the Report (pdf).