Harvey, Beth--WA

As the president of the Washington Chapter of the American Academy of Pediatrics, I would like to comment on the following factors that influence the quality of care provided to children under Medicaid and CHIP in our state. If you were to ask us, “How would you improve children's coverage and care?” We would answer, “Pediatricians and the medical home model provide the most cost effective care and the highest quality care. Children don't have access to pediatricians and a medical home unless pediatricians are reimbursed adequately for the cost of delivering care.” Only 43% of Hispanic and 42% of children with special health care needs in our state have a medical home. Our most impoverished families are the least likely to have access to a medical home as 43% of families living at 0-99% of FPL have a medical home in our state. In our state Medicaid inadequately reimburses the vaccine administration rate, does not pay for developmental screening by pediatricians, and does not recognize after hours codes. Managing prescriptions, which often require prior authorizations, and referrals, where access to specialists can be limited, are more difficult and time consuming for our Medicaid patients than our privately insured patients. Our state Medicaid program does not recommend the 15 month and 30 month preventive care visits as modeled in Bright Futures, nor yearly exams in school age children. Many of our Regional Support Networks for mental health care do not provide pediatric appropriate care such as cognitive behavioral therapy for anxiety. This not only doesn’t serve the best interests of these children, but potentially adds costs to the system as psychotropic medications may be needed when appropriate therapy is not accessible. On the positive side, Medicaid in our state does cover oral health instruction and fluoride varnish application in the medical home. Most clinics are now linked in to CHILD PROFILE, our state immunization registry. Thank you.