- Demographics of Children with Special Needs
- Percentage of Insured/Uninsured Children Who Have Special Health Care Needs (California & U.S. Only)
- Percentage of Insured/Uninsured Children Who Have Major Disabilities, by City, School District, and County (Regions of 65,000 Residents or More)
- Access to Services for Children with Special Health Care Needs (State-Level Data)
- Children with Special Health Care Needs Who Needed Five or More Services
- Children with Special Health Care Needs Who Had Preventive Medical Visit in the Last Year
- Difficulty Accessing Community-Based Services for Children with Special Health Care Needs
- Early Intervention for Children with Special Health Care Needs
- Referrals to Specialty Care for Children with Special Health Care Needs
- Unmet Medical Care Needs Among Children with Special Needs
- Unmet Needs for Mental Health Care Among Children with Special Health Care Needs
- Unmet Needs for Preventive Dental Care Among Children with Special Health Care Needs
- Usual Source of Health Care Among Children with Special Health Care Needs
- Youth with Special Health Care Needs Who Received Needed Services for the Transition to Adulthood
- Insurance Coverage for Children with Special Health Care Needs (State-Level Data)
- Quality of Care for Children with Special Health Care Needs (State-Level Data)
- Children with Special Health Care Needs Who Receive Care that Meets Federal Minimum Quality Standards
- Family-Centered Health Care for Children with Special Health Care Needs
- Medical Home for Children with Special Health Care Needs
- Dental Care
- Pupil Support Service Personnel
- Health Care
- Delayed or No Medical Care
- Health Insurance Coverage (Regions of 65,000 Residents or More), by Type of Insurance and Age
- Health Insurance Coverage (Regions of 20,000 Residents or More), by Type of Insurance and Age
- Health Insurance Coverage (Regions of 10,000 Residents or More), by Type of Insurance and Age
- Length of Time Since Last Routine Health Check-Up
- Medi-Cal Enrollment
- Medical Home Access (California & U.S. Only)
- School Health Centers
- Uninsured at Any Point in Last Year
- Visited the Emergency Room in Last Year, by Type of Insurance
- Prenatal Care
- Teen Sexual Health
- Why This Topic Is Important
According to the American Academy of Pediatrics, every child should receive high quality, culturally competent, coordinated, comprehensive, and preventive health care (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 like to have annual, preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have unmet medical and dental needs (2). According to 2011-12 estimates, 9% of U.S. children lacked a usual source of health care (3). Not surprisingly, children without health insurance are far more likely to have no usual source of care than children with insurance (4). In 2011-12, approximately 8.3 million U.S. children (11% of all kids) were uninsured at some point during the year (3).
One convenient way for children and youth to access needed health services is through school-based health centers. Nearly 2,000 centers currently operate nationwide (5). These health centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, including primary medical care, behavioral health, dental care, substance abuse counseling, and nutrition education (5). Research has found that school-based health centers can lead to improved health care access, increased school attendance, and reduced inappropriate emergency room visits among youth (6).
For more information on health care, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Hagan, J. F., et al. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from: http://brightfutures.aap.org/pdfs/Guidelines_PDF/1-BF-Introduction.pdf
2. Strickland, B. B., et al. (2011). The medical home: Health care access and impact for children and youth in the United States. Pediatrics, 127(4), 604-611. Retrieved from: http://pediatrics.aappublications.org/content/early/2011/03/14/peds.2009-3555
3. Child and Adolescent Health Measurement Initiative. National Survey of Children's Health. Data Resource Center for Child and Adolescent Health. Retrieved from: http://www.childhealthdata.org/learn/NSCH
4. Federal Interagency Forum on Child and Family Statistics. (2013). Health care. America’s children: Key national indicators of well-being, 2013. Washington, DC: U.S. Government Printing Office. Retrieved from: http://www.childstats.gov/americaschildren/care.asp
5. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2011). School-based health centers. Retrieved from: http://www.hrsa.gov/ourstories/schoolhealthcenters/
6. National Association on School-Based Health Care. (n.d.). Benefits of school based health care: Fact sheet. Retrieved from: http://www.nasbhc.org/site/c.ckLQKbOVLkK6E/b.7526255/k.9AF9/SBHC_Fact_Sheets.htm
- How Children Are Faring
In 2012, an estimated 92% of California children ages 0-17 had health insurance. Although the percentage of children with health insurance has increased slightly since 2009, gaps remain. According to 2012 estimates, 10% of Latino children in California did not have health insurance, compared to 6% of African American/Black, Asian American, and multiracial children, and 5% of white children.
In 2012, over 4 million children and youth ages 0-21 in California were enrolled in the Medi-Cal program: 353.4 per 1,000. The number and rate of enrollees has increased since 2004. Enrollment rates are highest among infants and lowest among young adults ages 19-21 (601 vs. 175.2 per 1,000 in 2011, respectively). African American children/youth have the highest enrollment rates among all racial/ethnic groups with available data in California (570.2 per 1,000 in 2011).
Among youth ages 12-17, 86% received a routine health check-up within the past 12 months in 2011-12, up from an estimated 77% in 2001. However, according to 2011-2012 data, less than half (45%) of California children ages 0-17 received care within a “medical home,” compared to 54% nationwide. In California and nationwide, older, low-income, Latino, and African American children were less likely to have a medical home.School health centers provide access to health care for many children. According to 2013 data, California has 226 school health centers, up from 153 in 2009. However, school health centers are not dispersed equally across the state. In 2013, a majority of counties (31 of 58) did not have any school health centers, and Los Angeles County alone had almost one-third of all health centers in the state.
- Policy Implications
When children have health insurance, they are more likely to receive preventive and acute care, they miss less school, and their families are at less financial risk from unpaid medical bills (1, 2). Providing quality, accessible and affordable health care to children requires comprehensive insurance coverage for all children; an appropriately trained and compensated provider base, including a sufficient number of subspecialists; parental understanding about what care is needed and how to obtain it; and effective systems of care, including a “medical home” (3). 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 (4).
The 2010 passage of the federal Affordable Care Act (ACA) will allow an estimated 95% of children in the U.S. access to affordable health care (9). The ACA expands Medicaid, the government health insurance program for low-income people, ensuring coverage of children in families earning up to 133% of the federal poverty level (10). In addition, families with incomes between 133%-400% of the federal poverty level, and without affordable employer-based coverage, will be eligible for subsidies to purchase coverage through the state's Health Benefit Exchange (10). ACA also prohibits discrimination based on pre-existing conditions and makes significant investments in school-based health care and infant care (11).
According to research and subject experts, policy options that could improve children’s health care include:
For more policy ideas and research on this topic, see kidsdata.org's Research & Links section or visit the California HealthCare Foundation, the 100% Campaign, and the American Academy of Pediatrics.
- Maintaining continuous insurance coverage for all low-income children, including immigrant children (1, 2)
- Ensuring that every child has access to family-centered, culturally competent and coordinated care within a medical home, particularly children with chronic conditions (3, 5, 7)
- Expanding access to health education and consultation services for parents/guardians and service providers in programs that serve young children, including child care settings, nutrition programs, and foster care homes (5)
- Ensuring that training is provided to pediatricians on medical home implementation and management of care for children with special health care needs; and ensuring that there is an adequate number of trained pediatric specialty care providers (3, 6)
- Adopting, funding, and supporting effective use of efficient application and enrollment processes, such as web-based systems that provide a one-stop approach to enrollment in various public and private health, social service, and other programs (8)
- Ensuring that public insurance reimbursement for pediatric visits covers the time required to focus on child/youth development, family-centered care and – for teens – sexual and reproductive health (2, 5)
Sources for this narrative:
1. Galbraith, A., et al. (2005). Out-of-pocket financial burden for low-income families with children: Socioeconomic disparities and effects of insurance. Health Services Research, 40(6 Pt. 1), 1722-1736. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361224/
2. 100% Campaign. (2010). Why coverage is important. Retrieved from: http://www.100percentcampaign.org/coverage/?_c=y6v0ow3cdxxnin
3. American Academy of Pediatrics. (2012). The medical home: Health care access and impact for children and youth in the United States. Pediatrics 127(4), 604-611. Retrieved from: http://pediatrics.aappublications.org/content/127/4/604.full
4. Center for Poverty Research. (2013). Policy brief: State health insurance policy and insuring immigrant children. Retrieved from: http://poverty.ucdavis.edu/research-paper/policy-brief-state-health-insurance-policy-and-insuring-immigrant-children
5. Zero to Three. (2009). Ensuring good physical health of our infants and toddlers. Retrieved from: http://main.zerotothree.org/site/DocServer/HealthSinglesMar5.pdf?docID=7888
6. National Center for Medical Home Implementation. (2011). Educating medical students and residents on medical home. American Academy of Pediatrics. Retrieved from: http://www.medicalhomeinfo.org/training/residency.aspx
7. Lucile Packard Foundation for Children’s Health. (2013). Children with special health care needs: A profile of key issues in California. Retrieved from: http://lpfch-cshcn.org/publications/research-reports/children-with-special-health-care-needs-in-california-a-profile-of-key-issues/
8. Mathematica Policy Research. (2012). Health-e-App public access: A new online path to children’s health care coverage in California. Retrieved from: http://www.mathematica-mpr.com/Health/health-e-app.asp
9. Children’s Defense Fund. (2011). New investments to help children and families: The Patient Protection and Affordable Care Act and the maternal, infant, and early childhood home visiting program. Retrieved from: http://www.childrensdefense.org/child-research-data-publications/data/new-investments-to-help-children-early-childhood-home-visiting-program.pdf
10. Georgetown University Health Policy Institute: Center for Children and Families. (2010). Summary of Medicaid, CHIP, and low-income provisions in health care reform. Retrived from: http://ccf.georgetown.edu/ccf-resources/summary-of-medicaid-chip-and-low-income-provisions-in-health-care-reform
11. 100% Campaign. (2012). Affordable Care Act: Top 11 benefits for California children and youth. Retrieved from: http://www.100percentcampaign.org/whatsnew/release.php?_c=11l5uswjv7q5w3z&1=1&id=10fdraalsifds47&done=.11l5utg1j5r2wdn
- Websites with Related Information
- California HealthCare Foundation
- California School Health Centers Association
- Child and Adolescent Health, Agency for Healthcare Research and Quality
- Child Health USA, U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
- Family Health Outcomes Project, UCSF
- Health Affairs
- Health Insurance and Access to Care Knowledge Path, Maternal and Child Health Library at Georgetown University
- Mathematica Policy Research: Medicaid and The Children’s Health Insurance Program
- National Academy for State Health Policy (NASHP)
- National Center for Medical Home Implementation, Maternal and Child Health Bureau & American Academy of Pediatrics
- Prevention Institute
- Robert Wood Johnson County Health Rankings & Roadmaps
- Robert Wood Johnson Foundation Commission to Build a Healthier America
- Social Determinants of Health, Centers for Disease Control and Prevention
- The Center for Health and Health Care in Schools, George Washington University
- The Children's Partnership: Children's Health Care/Health Reform
- The Commonwealth Fund
- UCLA Center for Health Policy Research
- Key Reports
- Adolescent Use of School-Based Health Centers and High School Dropout, 2011, Archive of Pediatric Adolescent Medicine, Kerns, et al.
- America’s Future: Latino Child Well-Being in Numbers and Trends, 2010, National Council of La Raza & Population Reference Bureau, Foxen, P., & Mather, M.
- Child Health Research: Identifying Quality Problems and Improving Care, 2010, Agency for Healthcare Research and Quality
- Covering Kids: Children's Health Insurance in California, 2012, California HealthCare Foundation
- Health at School: A Hidden Health Care System Emerges from the Shadows, 2007, Health Affairs, Graham-Lear
- Including Safety-Net Providers in Integrated Delivery Systems: Issues and Options for Policymakers, 2012, The Commonwealth Fund & The National Academy for State Health Policy, Witgert & Hess
- Pediatric Medical Homes: Laying the Foundation of a Promising Model of Care, 2011, National Center for Children in Poverty, Bachrach et al.
- Racial and Ethnic Disparities in the Health and Health Care of Children, 2010, Pediatrics, Flores
- Recommendations to Improve Preconception Health and Health Care --- United States, 2006, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Johnson et al.
- School-Based Health Centers: National Census School Year 2007-2008, 2009, National Assembly on School-Based Health Care
- Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011, The Commonwealth Fund, How, S., et al.
- Systems of Care Coordination for Children: Lessons Learned Across State Models, 2010, The Commonwealth Fund, Silow-Carroll & Hagelow
- The Language Spoken at Home and Disparities in Medical and Dental Health, Access to Care, and Use of Services in U.S. Children, 2008, Pediatrics
- The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care, 2005, Health Affairs, Lillie-Blanton & Hoffman
- The Youngest Americans: A Statistical Portrait of Infants and Toddlers in the United States, 2013, Child Trends, Murphey, D., Cooper, M., & Forry, N.
- Transforming The U.S. Child Health System, 2007, Health Affairs, Halfon, DuPlessis & Inkelas
- Unclaimed Children Revisited: California Case Study, 2010, National Center for Children in Poverty, Cooper, J., et al.
- Uninsured Children 2009-2011: Charting the Nation’s Progress, 2012, Georgetown University Health Policy Institute Center for Children & Families, Alker, Mancini & Heberlein
- County/Regional Reports
- Changing the Odds for Our Children: Santa Clara County Children's Agenda, 2012, Kids in Common
- Children's Report Card: Sacramento County Children's Coalition, 2013
- Expanding Coverage for Children: Santa Clara County's Children's Health Initiative, Mathematica Policy Research Inc.
- Final Report of the Evaluation of the San Mateo County Children's Health Initiative, 2008, Urban Institute, Howell, E., et al.
- Fresno Community Scorecard, Fresno Business Council and ValleyPBS
- How Policy Changes Impact Enrollment: A Look at Three Counties, 2004, California HealthCare Foundation, The Lewin Group
- San Diego County Report Card on Children & Families, 2011, The Children's Initiative and Johnson Group Consulting, Inc.
- Santa Barbara County Children's Scorecard, 2010, Santa Barbara County KIDS Network
- Solano County Children's Report Card, 2013, Children's Network
- Tulare County Children’s Report Card 2010, 2011, Children's Services Network
- Using Web Technology for Public Program Enrollment: Assessing One-e-App in Three California Counties, 2009, California HealthCare Foundation, Ange, E., et al.