NHeLP Health Principles for Child and Adolescent Health Reform

NHeLP Health Principles for Child and Adolescent Health Reform

Executive Summary

The National Health Law Program announced that guaranteed coverage, comprehensive coverage, coverage that is easy to obtain and retain, and coverage that is easy to use as necessary components of health reform and health care for vulnerable children and youth.

The National Health Law Program announced the following principles as necessary components of health reform and health care for vulnerable children and youth:

1. Guaranteed coverage. Children and youth meeting the eligibility thresholds (if any) would be entitled to receive covered services when needed and would have established comprehensive methods of redress when eligibility and/or services are denied, reduced, terminated or unreasonably delayed. The pre-DRA Medicaid program embodied this principle.

2. Comprehensive coverage. Health services (medical, mental health, dental, vision, and hearing) should be comprehensive, including routine preventive services and treatments and services to correct or ameliorate physical and/or mental conditions. The current Medicaid EPSDT provisions as set forth in 42 U.S.C. §§ 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r), embodies this principle.

3. Coverage that is easy to obtain and retain. Health coverage should be efficiently provided?easy to obtain and retain and easily understood by care givers and youth. Current programs that include one-stop enrollment, simplified applications and application processes, and automatic coverage offer exemplary ingredients (e.g. automatic enrollment of infants at birthing sites; automatic enrollment of those who qualify for other programssuch as Head Start, WIC).

4. Coverage that is easy to use. Children and adolescents should be able to obtain comprehensive health education and access to on-site or referral health services through medical homes that are person- and family-centered; geographically, linguistically and culturally accessible; that focus on keeping children and youth physically and mentally healthy; and that effectively manage health problems, chronic conditions and/or disabilities in order to eliminate or reduce existing health disparities.

5. Policy that works to ensure healthy children and youth. Policies should operate to keep children and youth as healthy as possible, thus focusing on diet, exercise and the environment.

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