Health and Medicine – InsuranceNewsNet

2022 NOV 10 (NewsRx) — By a News Reporter – Staff News Editor at Daily Insurance News — Detailed data on agriculture were presented. According to reports from Chicago, Ill., by NewsRx correspondents, the research said, “Importance: Families of children with medical complexity (CMC) report barriers to accessing affordable coverage for the full range of services their children may need to optimize their health outcomes. Enrolling in Medicaid through medical need-based eligibility mechanisms can help fill these service gaps.

Our reporters got a quote from the research of Department of Pediatrics: “Understanding state-to-state variations in how CMC accesses Medicaid can enable policymakers and pediatricians to help families navigate needed services for CMC. Clarify how eligibility and CMC coverage differ for Medicaid recipients across states with differing policies and managed care penetration.Design, Setting, and Participants: This qualitative study used semi-structured interviews with Medicaid representatives from 23 states and washington d.c.of February 1, 2020at March 1, 2021. Enrollment pathways and coverage processes were discussed. The interviews were transcribed and a content analysis was performed. Participants included Medicaid directors, a designate, or a state-identified policy official with expertise and/or responsibility in child-focused programs. Exposures: State variation in Medicaid eligibility and benefit policies. Key Results and Metrics: Eligibility pathways and coverage mechanisms for CMC in each state. A total of 43 informants from 23 states and washington d.c., participated, allowing data to be collected for nearly half of the United States. Four distinct eligibility pathways have been characterized, including 3 specific to the CMC, and pathways that include the presence of waiting lists have been distinguished. Additionally, 3 types of state-level coverage have been identified, consisting of fee-for-service, Medicaid-managed care, or both.

According to the journalists, the research concluded: “Two main links between pathways and mechanisms of coverage of CMC have been described. Conclusions and Relevance: The results of this qualitative study suggest that state patterns of Medicaid eligibility and coverage for CMC have implications for access, including some states with significant waiting times for these families. Future work is needed to understand the implications of these differential eligibility pathways based on Medicaid medical need and subsequent coverage mechanisms on resource utilization and health care expenditures, as well as considerations regarding challenges. CMC families face due to state-to-state variations. ”

For more information on this research, see: Features of Medicaid Policies for Children with Medical Complexity by State. Open JAMA Network, 2022.5(10). (JAMA Network Open – https://jamanetwork.com/journals/jamanetworkopen). The publisher of JAMA Network Open is American Medical Association (AMA).

A free version of this review article is available at https://doi.org/10.1001/jamanetworkopen.2022.39270.

Our editors report that additional information can be obtained by contacting Jennifer D. Kusma, Division of Advanced General Pediatrics and Primary Care, Department of PediatricsAnn & Robert H. Lurie Children’s Hospital Chicago and Northwestern University Feinberg School of Medicine, Chicago, Ill., United States. Other authors of this research include Matthew M. Davis, Caroline Foster.

(Our reports provide factual information on research and discoveries around the world.)

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