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Medicaid Matters for Children

 


More than 33 million children from low-income families and/or with special health care needs rely on Medicaid, making it the single largest insurer for children in​ the country.

Unlike private insurance, Medicaid is designed around the unique health needs of children. The program saves long-term health costs by screening for and treating preventable, complex conditions through its Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which is the "gold standard" for children's care. EPSDT provides Medicaid enrollees under the age of 21 with screening and diagnostic services, such as vision, dental and hearing exams, well-child visits, physician and hospital visits, and immunizations. In addition, all medically necessary services to treat the child are covered.

Working hand-in-hand with the Children's Health Insurance Program (CHIP), Medicaid has brought the uninsured rate among children to less than 8%. Looking forward, the Academy will continue to work at the federal level to keep Medicaid strong.

Additional resources:

  • State-by-state Medicaid fact sheets from the AAP in partnership with the Children's Hospital Association
  • July 2015 AAP News Washington Report Column, "Medicaid turns 50: a look back and ahead at program's legacy"

Medicaid Payment Equity

Preserving a strong Medicaid program is essential to ensuring that all children have coverage and access to care, but Medicaid faces serious financial threats that ca​n endanger the health of children. Children on Medicaid make up more than 30% of a pediatrician's patient population on average, but Medicaid pays only 70% of what is paid to treat a Medicare enrollee. Without consistent payments, fewer physicians may be able to participate in Medicaid, limiting the number of pediatricians who are able to treat children, increasing wait times for appointments, or forcing families to travel long distances to seek care.

In 2013 and 2014, the Affordable Care Act (ACA) increased Medicaid payment rates for primary care services to at least those paid by Medicare for calendar years 2013 and 2014. Despite advocacy efforts by the Academy and other health organizations, the 113th Congress did not extend Medicaid payment parity before federal funding for the payments expired. Additionally, the U.S. Supreme Court ruled that physicians can no longer challenge low Medicaid payment rates in the case Armstrong v. Exceptional Child Center. The AAP issued a response following the ruling expressing disappointment.

For the current session of Congress, the Ensuring Access to Primary Care for Women & Children Act is under consideration. This AAP-endorsed legislation would extend the 100% payment rate given to eligible providers to include OB-GYNs, advanced practice clinicians, rural health clinics, nurse practitioners, physician assistants, and certified nurse-midwives. This extension was considered as an amendment to the Medicare Access and CHIP Reauthorization Act, but was not included in final passage.

Click here to read a summary of the bill introduced in the Senate, and click here to read a summary of the bill introduced in the House.

Additional Federal and State Resources

  • AAP letter in support of the Ensuring Access to Primary Care for Women & Children Act introduced in the House
  • A map outlining 15 states' plans to extend some version of the Medicaid payment increase using state dollars.
  • StateHealth Resource – Medicaid Payment Increase for Primary Care Physicians 2013-2014
  • Web page on state advocacy efforts to extend Medicaid pay equity
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