Access to Health Insurance and Medical Homes
CRITICAL
COMPONENT
Access to
Health
Insurance and
Medical Homes
FINDINGS
Unmet Needs and Challenges
*Approximately 10% of MD children ages 0-6 are uninsured.
*Only two thirds of MD children ages 0-5 have access to a medical home that meets the AAP
definition (National Children’s Health Survey 2006).
*Barriers to establishing medical homes: Limited time per visit in the physician’s office due to high
physician case loads (e.g., 30 children per day). High case loads are result of low reimbursement
rates; Lack of specialty providers for referrals; Lack of resource guides; physician offices are often
unaware of referral resources; Poor communication across providers (e.g., physicians and case
managers; primary and specialty care providers).
* Approximately 40% of Maryland pregnancies are unintended (i.e., mistimed).
* Low birth weight, a risk factor for several medical and handicapping conditions, and infant
mortality. (Vital Statistics 2004).
*Maryland’s infant mortality rate is above the national average.
*Early prenatal care rates are declining.
*Less than half of mothers continue to breastfeed at six months (WIC data 2004).
*An estimated 600 babies seen each year in Maryland have fetal alcohol spectrum disorder (FASD),
a condition that is often under-diagnosed, but has life long consequences.
*Asthma and lead poisoning affecting health disparities among young children.
*About one third of children enrolled in WIC are overweight or at risk for obesity.
*Access to oral health care is limited for low income (Medicaid enrolled) children and families and
children with special health care needs due to unavailability of providers.
*Culturally competent providers identified by Latina mothers (language barriers).
*Many Maryland women of childbearing age lack access to preventive, primary and preconception
services. An estimated 15 to 25% of these women are uninsured (Medicaid data).
*Significant racial/ethnic perinatal disparities persist (Vital Statistics).
MCH Strengths and Capacity to Address
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MCH provides subsidized family planning services to 78,000 women each year
Within DHMH, a state plan to address issues of Medical Home in CSHCN has been
developed and envisions: All Maryland CYSHCN will receive comprehensive care through
a medical home partnership. Medical home partnerships will result in improved health,
functioning, and quality of life for Maryland CYSHCN and their families. Medical home
partnerships will also result in increased professional satisfaction for pediatric health care
providers.
Sustaining medical homes and expanding dental access through MCH partnerships with
Medicaid and AAP.
MCHP- 250%FPL for prenatal care; 300% FPL for children including dental care.
Immigrant Health Initiative for uninsured immigrant pregnant women and children.
Title V agency has highly experienced clinical staff in all MCH and CSHCN disciplines
Best Practices and Key Findings: Access to Health Insurance and Medical Home
Access to medical homes can minimize barriers to care and ensure healthy development
to better prepare a child for kindergarten entry. By promoting best practices, protocols,
and medical home standards we will ensure that health care coverage provides for
medical home reimbursement and implements an appropriate infrastructure. Children
will receive consistent care in a medical home with each child achieving age appropriate
milestones and will also receive referrals for further evaluation and treatment. Through
new partnerships, oral health services will be initiated earlier and children will not
experience pain, dental infection or untimely loss of teeth. Providers will discuss their
reluctance to accept children living in poverty and those with CSHCN, and they will
assist in developing strategies to address the maldistribution of providers throughout the
state.
A medical home provides health care that is accessible, family-centered,
continuous, comprehensive, coordinated, compassionate, and culturally effective.1 The
2005 National Survey of Children’s Health defines a medical home as having at least one
preventative visit in the past year, had little or no problem with access to specialty care,
and reported having a personal doctor or nurse who usually or always spent enough time
and communicated clearly with families, provide telephone advise or urgent care when
needed, and followed up with the family after the child’s specialty care visits.2 The
medical home concept has been endorsed by professional organizations such as the
American Academy of Pediatrics and the American Academy of Family Physicians and
by family organizations such as Family Voices.
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Access to effective and appropriate pediatric health care services are a key
component of any early childhood system.
Many pediatric providers are not well trained to assess, intervene and refer
children with developmental, behavioral and psycho-social problems, despite
recognition of these issues as central to pediatric care.
According to the 2001 National Survey of CSHCN, children without medical
homes are more likely to report one or more unmet needs including: substance
abuse treatment, mental health care access, dental care access and family support
services.
The U.S. Government has set increasing access to social services and health care
as a priority for the nation. Accessing available services continues to be a large
problem for the health of children in Maryland
The Rand Corporation explains that lack of access to consistent primary care
could be overcome with a quality single point of entry system in place.
The State of Utah is the leader in single point of entry system called “Utah
Clicks.”3 This program makes it easier and faster to apply for multiple state
programs all at the same time. The University of Utah has preliminary data on the
first year of the Utah clicks program and shows that over the past four months
(January through April), 903 applications were submitted through their on-line
system and Oregon and Indiana have recently adopted the system for their states .4
The American Academy of Pediatrics cites low reimbursement as one of the most
critical reasons that pediatricians do not accept Medicaid patients. In a survey it
was found that over 30% of pediatricians stated they would participate more and
accept more Medicaid and state children’s health program (SCHP) patients if
reimbursements were increased.5
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If a reimbursement increase was implemented across all health care payment
programs (private and government funded medical insurance), more health
providers report they could care for those receiving medical assistance or even
possibly the uninsured.