Senior Project Director Meg Comeau Shares Expertise on Health Care Financing for Children and Youth with Special Health Care Needs 

Children and youth with special health care needs (CYSHCN) require specialized health care services, and, consequently, their families often incur higher financial costs. Approximately 25% of children in the United States qualify as CYSHCN, and their health care costs are on average twice those of children without special health care needs. In a new peer-reviewed primer published in Pediatric Clinics of North America, Meg Comeau, senior project director at the Center for Innovation in Social Work and Health (CISWH) at BU School of Social Work, highlights the complex financing systems that impact CYSHCN, along with opportunities to improve access to care and long-term outcomes. 

Health Care Financing Extends Beyond Direct Medical Care 

CYSHCN often need specialty care, medications, therapies, home and community-based services, and care coordination. Families may also face economic impacts that are harder to measure, including unpaid caregiving, housing, utilities and transportation expenses, and lost employment income. 

Medical Insurance Design Impacts Access to Needed Care 

The services an insurance plan covers, its provider network, and out-of-pocket costs to families can affect whether families are able to access necessary care for their children. More than one-third of caregivers of CYSHCN report that their child’s insurance coverage is inadequate. 

Medicaid Plays an Important Role in Health Coverage 

Medicaid provides health coverage for about half of CYSHCN and may serve as either a primary or secondary payer. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit also requires coverage of medically necessary services for enrolled children, improving access to care and limiting cost-sharing for families. 

Reshaping Health Care Financing for CYSHCN 
 
Family and patient perspectives are essential to the design and evaluation of health care financing, as they are the ones impacted most directly by inadequacies that aren’t captured routinely, including lost employment due to caregiving and care coordination provision. Financing for CYSHCN should prioritize in-home care and align with family-identified needs. The authors also recommend further research on new models of financing and insurance design with optimal outcomes for CYSHCN in mind.  As the CYSHCN population continues to grow, thanks to developments in medical technology and care, it’s important that CYSHCN health care financing is seen as a long-term investment in child health and development.  

Read the full article here.