Research and Links
Insurance Coverage for Children with Special Health Care Needs (see data for this topic)
- Websites with Related Information
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- Association of Maternal and Child Health Programs (AMCHP)
- California Dept. of Health Care Services: California Children's Services
- Catalyst Center. Boston University School of Social Work.
- Center for Parent Information and Resources. Statewide Parent Advocacy Network.
- Children's Regional Integrated Service System (CRISS)
- Disability Rights California
- Family Voices
- Got Transition: Resources and Research. National Alliance to Advance Adolescent Health.
- Health Affairs. Project HOPE.
- Lucile Packard Foundation for Children's Health: Program for Children with Special Health Care Needs
- Maternal and Child Health Bureau: Children with Special Health Care Needs. U.S. Dept. of Health and Human Services.
- Mathematica: Disability
- National Academy for State Health Policy (NASHP)
- Support for Families of Children with Disabilities
- Key Reports and Research
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- A State Multi-Sector Framework for Supporting Children and Youth with Special Health Care Needs. (2018). Lucile Packard Foundation for Children’s Health. Child Trends.
- Building Systems That Work for Children with Complex Health Care Needs. (2018). Pediatrics. Agrawal, R., & Stille, C. (Eds.)
- Children with Special Health Care Needs Face Challenges Accessing Information, Support, and Services. (2020). Child Trends. Abdi, F. M., et al.
- Children with Special Health Care Needs: NSCH Data Brief. (2020). Health Resources and Services Administration, Maternal and Child Health Bureau.
- Fundamentals of Financing the System of Care for Children and Youth with Special Health Care Needs (CYSHCN) (2019). Catalyst Center. Comeau, M., et al.
- Hidden in Plain Sight: California Children Using Long-Term Care Services. (2015). Lucile Packard Foundation for Children's Health & Learning Partnerships. Brousseau, R., & MacDonald, S.
- In Their Own Words: Improving the Care Experience of Families with Children with Special Health Care Needs. (2015). Lucile Packard Foundation for Children’s Health & University of California San Francisco. Hughes, D.
- Keeping Medicaid’s Promise: Strengthening Access to Services for Children with Special Healthcare Needs. (2019). Manatt Health, et al. Mann, C., et al.
- Opportunities for Improving Programs and Services for Children with Disabilities. (2018). National Academies of Sciences, Engineering, and Medicine.
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems. (2018). Pediatrics. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee.
- Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP) (2017). Catalyst Center. Rosenthal, J., et al.
- Standards for Systems of Care for Children and Youth with Special Health Care Needs: Version 2.0. (2017). Lucile Packard Foundation for Children's Health. Association of Maternal and Child Health Programs, et al.
- More Data Sources For Insurance Coverage for Children with Special Health Care Needs
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- Data Resource Center for Child and Adolescent Health. Child and Adolescent Health Measurement Initiative.
Learn More About This Topic
- Why This Topic Is Important
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More than 1 million California children and youth have a need for health care services of a type or amount beyond that required by children generally. Their ongoing health problems—physical, behavioral, or developmental—can affect their ability to function and participate in important educational and social activities. In some cases their health problems can shorten their lives (1). Medical care for children with special health care needs (CSHCN) is often complicated by the co-occurrence of social, emotional, and academic problems (1, 2). Because of the higher caregiving burdens, families of CSHCN tend to experience more stress and difficulties with employment and finances than other families (1, 2).
CSHCN account for more than 40% of all health care costs among children nationwide, despite making up only about 16% of the U.S. child population (1). Though advances in medical care have extended and improved the lives of millions of children, obtaining timely, appropriate, and affordable care remains a problem for many families. More than four in five CSHCN do not receive one or more basic aspects of quality health care, in California and nationally (1).
Access to adequate health insurance is an essential step in ensuring that CSHCN receive needed services (1, 3). Studies have shown that health insurance is particularly important for CSHCN, as coverage is associated with improved health care quality, fewer unmet needs, and having a usual source of care (3).For more information, see kidsdata.org’s Research & Links section and our Program for Children with Special Health Care Needs site.
Sources for this narrative:
1. Child and Adolescent Health Measurement Initiative. (2013). Children with special health care needs in California: A profile of key issues. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/children-special-health-care-needs-california-profile-key-issues
2. Hughes, D. (2015). In their own words: Improving the care experience of families with children with special health care needs. Lucile Packard Foundation for Children’s Health & University of California, San Francisco. Retrieved from: http://www.lpfch.org/publication/their-own-words-improving-care-experience-families-children-special-health-care-needs
3. Strickland, B. B., et al. (2015). Assessing systems quality in a changing health care environment: The 2009-10 National Survey of Children with Special Health Care Needs. Maternal and Child Health Journal, 19(2), 353-361. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936897 - Policy Implications
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Children and youth with special health care needs (CYSHCN), like all young people, need ready access to appropriate medical care, educational opportunities, and, sometimes, social services. CYSHCN, especially those with more complex conditions, may face challenges in obtaining timely access to pediatric subspecialty care and receiving comprehensive, coordinated, high quality health care (1, 2). They also may experience difficulties participating in school and recreational activities (1, 3). Their families, too, often have to manage economic, social, and personal burdens in excess of families without CYSHCN (1, 3).
Policies and programs to promote the health and well-being of CYSHCN and their families should address:- Comprehensive and consistent health care coverage: CYSHCN need comprehensive health insurance that provides adequate medical and mental health coverage, including access to specialty care providers (1, 4, 5). These children also need consistent coverage, without gaps that can cause delays or problems receiving critical services. Appropriate reimbursement is critical to maintaining an adequate provider network, as well (4, 5).
- High-quality, well-coordinated, and consistent services: CYSHCN benefit from evidence-based health care services provided in the context of a “medical home” that assures high quality, well-coordinated care (1, 2, 4).
- Family-centered care: Families are the most central and enduring influence in children’s lives, and most of children’s care depends on their families carrying out agreed-upon management plans. Families’ values, beliefs, goals, and priorities should help guide care plans, and families should be included as partners in all health care decision-making (1, 3, 4).
- Early and continuous screening: Systematic screenings for special health care needs beginning early in a child’s life have the potential to reduce long-term consequences of some chronic conditions. Such screenings help identify problems early and can provide an opportunity to assess the needs and strengths of families, as part of providing tailored and family-centered care (3, 4).
- Inclusion: Providing CYSHCN with opportunities for inclusion with other children in academic, social, and recreational settings is critical to their development and can maximize achievement and quality of life (6).
- Support for adulthood transition: As CYSHCN age, they need support from their health care, educational, and social service systems to successfully transition to adulthood. For example, they may need assistance to move from school to work or post-secondary education, from pediatric care to adult health care, and/or from family dependency to self-sufficiency (1, 4).
- Financing of care: Families of CYSHCN must navigate a complicated web of service systems with dueling eligibility criteria and confusing payment policies. This can result in delayed or denied services for children and financial hardship for families. State policy must work toward a unified, efficient, and comprehensive payment system for health care and developmental services, as well as ensuring adequate funding for public systems serving CYSHCN (1, 2, 4, 7).
For more information, see kidsdata.org’s Research & Links section and LPFCH's program for Children with Special Health Care Needs.
Sources for this narrative:
1. Child and Adolescent Health Measurement Initiative. (2013). Children with special health care needs in California: A profile of key issues. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/children-special-health-care-needs-california-profile-key-issues
2. Bachman, S. S., et al. (2015). The care coordination conundrum and children and youth with special health care needs. Catalyst Center & Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/care-coordination-conundrum
3. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013). The National Survey of Children with Special Health Care Needs Chartbook 2009-2010. Retrieved from: http://mchb.hrsa.gov/cshcn0910
4. Association of Maternal and Child Health Programs. (2014). Developing structure and process standards for systems of care serving children and youth with special health care needs. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/standards-systems-care-children-and-youth-special-health-care-needs
5. Gans, D., et al. (2013). Assuring children’s access to pediatric subspecialty care in California. UCLA Center for Health Policy Research & Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/assuring-children's-access-pediatric-subspecialty-care-california
6. American Occupational Therapy Association. (2015). Occupational therapy’s role in mental health promotion, prevention, and intervention with children and youth: Inclusion of children with disabilities. Retrieved from: https://www.aota.org/~/media/Corporate/Files/Practice/Children/Inclusion-of-Children-With-Disabilities-20150128.PDF
7. Schumacher, K. (2015). Children’s health programs in California: Promoting a lifetime of health and well-being. California Budget and Policy Center & Lucile Packard Foundation for Children’s Health. Retrieved from: http://calbudgetcenter.org/resources/childrens-health-programs-in-california-promoting-a-lifetime-of-health-and-well-being - How Children Are Faring
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Although an estimated 97% of California’s children with special health care needs (CSHCN) have health insurance coverage, just 68% of those who are insured have adequate coverage to meet their health needs, according to 2011-2012 data. Among CSHCN statewide, 60% had private insurance, 28% had public insurance, and 8% had both private and public insurance in 2009-2010.
At the local level, estimates of health insurance coverage among CSHCN were above 96% for all California cities and counties with at least 70,000 residents in 2011-2012. Estimates of insurance consistency—the measure of whether, over the past 12 months, there were no gaps in coverage—ranged from 81% to 97% among cities with data.
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