Private Coverage Under California's Affordable Care Act: Benefit and Cost-Sharing Requirements Affecting Children and Adolescents With Special Health Care Needs
by Peggy McManus and Harriette Fox, May 2013.
This issue brief examines the extent to which California’s essential health benefits benchmark plan meets the needs of children and adolescents, including those with special needs. It also examines the cost-sharing requirements that will be used by health insurance plans sold in California’s Health Insurance Exchange. It identifies potential issues of concern in the benchmark’s essential health benefits, with special attention to families’ out-of-pocket cost liabilities within all five levels of coverage, including subsidized coverage.
Health Reform and Adolescents
by Harriette B. Fox and Margaret A. McManus, June 2009.
This issue brief documents the significant health risks and conditions of adolescents and the financing and delivery system barriers that affect their access to appropriate care. It urges Congress to consider coverage expansions under Medicaid and CHIP, benefit and payment improvements, grant programs to support interdisciplinary models of primary care, and funds to improve training for adolescent health providers.
Structuring Health Care Reform to Work for Adolescents
by Harriette Fox, Margaret McManus, Stephanie Limb, and John Schlitt, November 2008.
This issue brief on health reform and adolescents examines four major themes for restructuring the health care financing and delivery system -- placing greater emphasis on prevention, redesigning primary care, changing payment incentives, and relying more on evidence-based care. For each topic, reform proposals are summarized, issues of concern to adolescents are reviewed, and new options for addressing adolescent needs are presented.
Preliminary Thoughts on Restructuring Medicaid to Promote Adolescent Health
by Harriette B. Fox, Stephanie J. Limb, and Margaret A. McManus, January 2007.
This issue brief examines state Medicaid benefit and payment policies affecting adolescents and concludes that they are inadequate to support the type of care that adolescents require. It includes a proposal for an enhanced set of health promotion and primary care benefits designed specifically for adolescents that can be offered through EPSDT or as an alternative benefit package under the Deficit Reduction Act and suggestions for possible changes to payment policies to support comprehensive preventive and primary care service delivery for adolescents.