Children with life-threatening illnesses that receive health care through Medicaid often rely on the emergency room for basic treatment.
Unfortunately, it’s a costly, disruptive way to treat a child with a deadly disease.
Unlike sick adults, seriously ill children often experience a higher volume of ups and downs in their health condition. Physicians and medical researchers have found that the best way to treat them is through an individualized program of continuous, comprehensive, coordinated, cost-effective, hospice-style care; something unfortunately Medicaid does not cover.
Currently, nearly 30% of the children in the United States who have life-threatening conditions qualify for Medicaid. These children are forced into a system that will only treat them on an emergency basis, sending them home to wait until their next health emergency-clearly not the best way to care for these children, nor the most cost effective.
But efforts to change this flawed approach are on the horizon. One such proposal, modeled on a program developed by Children’s Hospice International, is reflected in legislation (HR 6931) I have introduced giving states the option to provide continuous, coordinated care through the Children’s Program of All-Inclusive, Coordinated Care (ChiPACC). The program provides each enrolled child an individualized treatment plan that manages services from providers across the health care spectrum while avoiding relying on more expensive and often scary emergency room visits.
Under the traditional Medicaid model, individuals can receive only “hospice” services and only after their doctors give them a prognosis of six months to live. Children, however, are much more likely than adults to go in and out of terminal phases multiple times. No family should be forced to give up curative care for their child in order to receive services that are predicated on accepting that their child has no more than six months to live. ChiPACC addresses this problem by combining medical and support services currently available in Medicaid with counseling, respite, and other care that have previously only been available as hospice services.
With appropriate comprehensive and coordinated services under ChiPACC, many emergency episodes can be avoided or anticipated and managed. Children would receive care in their homes instead of in hospitals, so that even when they require critical care they can enter the hospital through the front door instead of the emergency room, significantly reducing health care costs.
More than one million children and their families stand to benefit from the ChiPACC program. ChiPACC is available today in some states through a complicated Medicaid waiver process. The legislation I introduced this Congress and plan to reintroduce in the next would make Medicaid a state option. Currently, Florida and Colorado have programs in operation, while New York and California are planning to initiate their programs this fall. It’s a great initiative that can save lives. I plan to pursue it aggressively next year in the new 111th Congress.