Payment barriers and provider network scarcity continue to bar families from obtaining necessary and timely specialty care. These barriers can be effectively bridged by offering incentives to specialists that are most needed by our families. Appropriate insurance reform that does not penalize children covered by state-supported insurance is crucial. New Jersey continues to make progress in the financing of healthcare for children with the Children’s Health Insurance Program (CHIP) and NJ Family Care, but substantial gaps remain.
Pediatric health services provided by private, public insurance plans and managed care organizations should cover all services as defined by Bright Futures and the Early and Periodic Screening, Diagnostic and Treatment benefit (EPSDT). To ensure pediatric access to needed services, Medicaid and Medicaid HMOs must implement payment parity with Medicare to pediatric providers and limit bundle payments for preventative services.
A study conducted by the University of Pennsylvania and published in the New England Journal of Medicine, reported that New Jersey achieved one of the country’s largest increases in patient access to Medicaid services when payments were increased to parity with Medicare. Conversely, an NJAAP survey revealed that the failure to renew these Medicaid parity payments resulted in a reduction, and in some cases, the elimination of these increased services throughout New Jersey.
A Medicaid Card Alone Does Not Ensure Access To A Pediatric Medical Home