“Underinsurance” Hinders Care for Many Children with Special Needs

The good news is that most of California’s children with special health care needs have health insurance. Unfortunately, that’s only part of the story. For nearly 40 percent of these children, their insurance coverage is inadequate to meet their needs, and low reimbursement policies make it extremely difficult for their families to find physicians and other care providers. As one parent of a special needs child said in a recent article from New America Media (NAM), “I called every therapist from Oakland to San Leandro, but none of them is willing to accept him.”

The NAM article, by Vivian Po, recounts the experiences of several Bay Area families, whose children have diagnoses that include cerebral palsy, Down syndrome, autism, Asperger’s syndrome, and epilepsy. The story highlights how program cuts brought about by California’s staggering budget deficit are worsening the underinsurance problem and taking a toll on families.

The issue is, of course, not limited to California. A national study published online March 8 in the journal Pediatrics notes that adequacy of insurance is strongly related to where a child lives, and that disparities exist within and among states. The authors conclude that legislation guaranteeing insurance for all children is important, but not sufficient. “If policymakers are interested in ensuring equitable treatment in the health care system for children with special health care needs, then policy initiatives aimed at reducing underinsurance and increasing uniformity of coverage across states are also needed,” they write.

A focus area for our foundation is improving the systems of care for kids with special needs, and adequate insurance must be a top priority. See our website at http://www.lpfch.org/informed/cshcn/.


Posted by David Alexander, MD

This entry was posted on Friday, March 19th, 2010 at 2:16 pm. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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  1. Betty Lin says:

    The problem goes beyond finding a doctor or a therapist who will take a family’s private insurance. These families face the challenge of finding doctors and therapists who specialize in pediatrics. There are not that many. Some families whose children with special needs require intensive therapies. Their insurance may only cover a limited number of therapy sessions, not nearly enough to meet these children’s needs. Although Regional Centers may pick up the tab left off by private insurances, a change of the funding source often interrupts the therapy services, leaving these children with special needs without any service for weeks or months while waiting for the next payor to get onboard. A change in doctors or therapists also means that these young children have to severe relationships with familiar therapists and reestablish relationships with new therapists. As those of us working with young children know, they do not respond well to frequent transitions and inconsistency in relationships. Policy changes due to CA’s budget crisis have had many unintended consequences to our most vulnerable population of young children with special needs.