Receipt of Care Within a Medical Home, by Income Level (Regions of 70,000 Residents or More)

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Learn More About Health Care

Measures of Health Care on Kidsdata.org
Kidsdata.org's health care measures include:
* Public health insurance includes both means-tested coverage (e.g., Medicaid/Medi-Cal, CHIP) and non-means-tested coverage (e.g., Dept. of Defense TRICARE, Indian Health Service). Means testing considers financial circumstances in determining eligibility.

† Medicaid is a federal program providing health coverage to eligible low-income children and families; Medi-Cal is California's Medicaid program. CHIP (Children’s Health Insurance Program) is a federal program providing coverage to children/youth up to age 19 in families with incomes too high to qualify them for Medicaid, but too low to afford private coverage. California’s CHIP program was called the Healthy Families Program (HFP). Although California continues to receive CHIP funding, in 2013 HFP enrollees were transitioned into Medi-Cal.

‡ According to the American Academy of Pediatrics, a medical home is a model of delivering primary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”
Health Care
Characteristics of Children with Special Needs
Demographics
Access to Services for Children with Special Health Care Needs
Cancer
Insurance Coverage for Children with Special Health Care Needs
Quality of Care for Children with Special Health Care Needs
Dental Care
Pupil Support Service Personnel
Hospitalizations
Immunizations
Prenatal Care
Teen Sexual Health
Why This Topic Is Important
According to the American Academy of Pediatrics, every child should receive high quality health care that is accessible, family-centered, culturally competent, coordinated, continuous, compassionate, and comprehensive (1). This care is best offered through a medical home, an ongoing family-centered partnership with a child health professional or team, in which all of the patient’s needs are met (1). Children who receive care in the context of a medical home are more likely to have regular preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have emergency room visits (1). However, the latest estimates indicate that only around half of children receive care within a medical home, statewide and nationally (2). Not surprisingly, children without health insurance are less likely to access needed care than those with coverage (3). While the number of insured children has increased in recent years, some remain uninsured and many are at risk of losing coverage if investments in public insurance programs are not maintained (3).
One convenient way for children and youth to access needed services is through school-based health centers (SBHCs). These centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, such as primary medical care, mental or behavioral health care, dental care, substance abuse services, and health and nutrition education. More than 2,300 SBHCs operate nationwide (4). These centers have become a key part of the health care delivery system, as children and youth spend a significant amount of time at school, and barriers such as transportation and scheduling are reduced. SBHCs can lead to improved access to medical and dental care, health outcomes, and school performance (5, 6). They also reduce emergency room visits and health care costs (5, 6).

For more information on health care, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  National Center for Medical Home Implementation. (2016). Why is medical home important? American Academy of Pediatrics. Retrieved from: https://medicalhomeinfo.aap.org/overview/Pages/Evidence.aspx

2.  As cited on kidsdata.org, Receipt of care within a medical home (regions of 70,000 residents or more). (2016). Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health.

3.  Schneider, L., et al. (2016). The Affordable Care Act and children’s coverage in California: Our progress and our future. The Children’s Partnership. Retrieved from: http://www.childrenspartnership.org/research-list/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future

4.  School-Based Health Alliance. (n.d.). National census of school-based health centers. Retrieved from: http://www.sbh4all.org/school-health-care/national-census-of-school-based-health-centers

5.  American Academy of Pediatrics Council on School Health. (2012). School-based health centers and pediatric practice. Pediatrics, 129(2), 387-393. Retrieved from: http://pediatrics.aappublications.org/content/129/2/387

6.  Community Preventive Services Task Force. (2016). Promoting health equity through education programs and policies: School-Based Health Centers. Retrieved from: https://www.thecommunityguide.org/findings/promoting-health-equity-through-education-programs-and-policies-school-based-health-centers
How Children Are Faring
According to estimates from a 2015 survey, 97% of California children ages 0-17 had health insurance at the time of survey—up from 91% in 2009—yet gaps remain. For example, 8% of American Indian/Alaska Native children were uninsured in 2015, compared to less than 5% for all other racial/ethnic groups with data.

Findings from the same survey show that 42% of California children and youth ages 0-21 had Medicaid (Medi-Cal), CHIP, or other means-tested public health insurance coverage, with enrollment estimates highest for infants and lowest for young adults ages 18-21. Coverage for African American/black and Hispanic/Latino groups was higher than 50% in 2015, whereas estimates for Asian/Pacific Islander and white children/youth were lower than 27%. In the 2016 federal fiscal year, total yearly enrollment in Medicaid and CHIP among California children ages 0-17 was 720 per 1,000, more than 20% higher than the national rate of 590 per 1,000.

Parent reports from 2011-12 show that fewer than half (45%) of the state's children receive care within a medical home, compared to 54% nationwide. In California counties with data, estimates of children receiving care within a medical home ranged from 37% (Imperial) to 59% (Marin). Statewide and nationally, estimates of care within a medical home are lowest for older, low-income, Hispanic/Latino, and African American/black children.
In 2013-14, an estimated 88% of California youth ages 12-17 received a routine health check-up within the past 12 months, up from about 77% in 2001. However, about 7% of all California children—and 10% of lower-income children—had no usual source of health care in 2013-14. Estimates by race/ethnicity ranged from 5% (multiracial and white) to 11% (African American/black) with no usual source of care. Among children who did have a regular source of care, the majority (63%) used a doctor’s office or HMO, rather than hospitals, clinics, urgent care, emergency rooms, or other settings. For children living below 200% of the Federal Poverty Level, only 48% used a doctor’s office or HMO, compared to 77% for children from higher-income families.

School health centers provide access to health care for many children. In 2017, California had 248 school health centers, up from 153 in 2009. However, half of the state's counties (29 of 58) did not have any school health centers in 2017.

In 2011-13, 57% of public school staff in California reported that they agreed or strongly agreed that their school provides students with adequate health services. Elementary school staff reported the highest percentage of agreement that their school provides adequate health services; non-traditional and K-12 school staff reported the lowest.
Policy Implications
Children with health insurance are more likely to receive needed medical care, are less likely to have costly hospitalizations, and tend to perform better in school than their uninsured peers (1). Providing quality, accessible, and affordable health care to all children requires comprehensive insurance coverage and an appropriately trained and compensated provider base including a sufficient number of subspecialists; it also requires effective systems of care including medical homes and parental understanding about what care is needed and how to obtain it (2, 3, 4). Immigrant children, especially those with undocumented parents or those who are themselves undocumented, are at particular risk of being uninsured and without regular health care (2, 5).

The 2010 Affordable Care Act (ACA), which expanded health care coverage and enacted other major health system changes, has increased the number of insured children in the state and nation (2). California also has enacted numerous policy and program changes in recent years, bolstering coverage and access to health care for millions of children and families (2). While progress has been made, ongoing efforts are needed to maintain these gains and to continue strengthening health care for children, particularly for low-income and vulnerable populations (2). Concerted efforts are especially critical given the current national policy context and uncertainty about the future health care system.

Policy options that could improve children’s health care include:
  • Supporting ongoing efforts to ensure continuous insurance coverage for all low-income children, including immigrant children; this includes maintaining and increasing investments in public insurance programs serving children and continuing to improve enrollment processes and community-based outreach to families (2, 5)
  • Ensuring that every child has access to family-centered, culturally competent, and coordinated care within a medical home, particularly children with chronic conditions (3, 6)
  • Increasing the number of health care providers serving children in Medi-Cal (California's Medicaid program) by improving financial incentives, and ensuring that reimbursement for pediatric visits covers the time required to focus on child/youth development and family-centered care (2, 4, 6)
  • Ensuring that there is an adequate number of pediatric specialty care providers and that pediatricians are trained on management of care for children with special health care needs, medical home implementation, and culturally effective pediatric practice (3, 4)
  • Expanding access to health consultation or education for parents/guardians and service providers in programs serving young children, such as child care settings, home-visiting programs, and foster care homes (6)
  • Monitoring the capacity and financial viability of safety-net providers, such as county hospitals, which are important sources of care for low-income people (7)
  • Promoting collaboration across sectors—health, education, social services, and others—to improve prevention, early intervention, and treatment services for children, and supporting a comprehensive approach to health care that goes beyond treating illness to addressing community factors that impact health, such as access to healthy food or safe housing; this could help reduce health inequities at the population level and lower costs related to preventable conditions (8, 9)
For more policy ideas and research on this topic, see kidsdata.org's Research & Links section or visit the California HealthCare Foundation, the National Academy for State Health Policy, and the American Academy of Pediatrics.

Sources for this narrative:

1.  Child Trends DataBank. (2016). Health care coverage. Retrieved from: https://www.childtrends.org/indicators/health-care-coverage

2.  Schneider, L., et al. (2016). The Affordable Care Act and children’s coverage in California: Our progress and our future. The Children’s Partnership. Retrieved from: http://www.childrenspartnership.org/research-list/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future

3.  National Center for Medical Home Implementation. (2016). Why is medical home important? American Academy of Pediatrics. Retrieved from: https://medicalhomeinfo.aap.org/overview/Pages/Evidence.aspx

4.  American Academy of Pediatrics Committee on Pediatric Workforce. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397. Retrieved from: http://pediatrics.aappublications.org/content/132/2/390

5.  American Academy of Pediatrics Council on Community Pediatrics. (2013). Providing care for immigrant, migrant, and border children. Pediatrics, 131(6), e2028-e2034. Retrieved from: http://pediatrics.aappublications.org/content/131/6/e2028

6.  Kossen, J., & Rosman, E. (2012). Leading the way to a strong beginning: Ensuring good physical health of our infants and toddlers. Zero to Three. Retrieved from: https://www.zerotothree.org/resources/996-leading-the-way-to-a-strong-beginning-ensuring-good-physical-health-of-our-infants-and-toddlers

7.  McConville, S. (2017). California's future: Health care. Public Policy Institute of California. Retrieved from: http://www.ppic.org/main/publication.asp?i=1020

8.  Halfon, N., et al. (2014). The changing nature of children’s health development: New challenges require major policy solutions. Health Affairs, 33(12), 2116-2124. Retrieved from: http://content.healthaffairs.org/content/33/12/2116.full

9.  Arkin, E., et al. (Eds.). (2014). Time to act: Investing in the health of our children and communities. Robert Wood Johnson Foundation Commission to Build a Healthier America. Retrieved from: http://www.rwjf.org/en/research-publications/find-rwjf-research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html
Websites with Related Information
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