Children’s Advocates Concerned About State Exchange Benefits
Children's health care advocates are concerned that some children who will gain insurance coverageÂ through the state's health exchange will not receive benefits equal to those offered under Medi-Cal, KQED's "State of Health" reports.
Medi-Cal is California's Medicaid program.
The American Academy of Pediatricians recommends a standard of children's care known as Early and Periodic Screening, Diagnostic and Treatment Services.
Children who are enrolled in Medi-Cal receive coverage that adheres to EPSDT.
Under the Affordable Care Act, children whose families meet certain income requirements will qualify for coverage through California's state health insuranceÂ exchange, named Covered California.
Details of Concerns
Kelly Hardy -- director of health policy at statewide advocacy group Children Now -- said essential health benefits required by the ACA for plans offered through state exchanges are "a huge step forward for children's health."
She said the organization also is pleased that California lawmakers "chose to add strong vision and comprehensive dental benefits for children" in regulations for plans offered through Covered California.
However, she said that lawmakers did not require that exchange plans adhere to EPSDT.
Thomas Long -- a physician and expert on child health financing with the American Academy of Pediatrics -- said the exchange's standard of care does not include coverage for mental health benefits and access to pediatric specialists, among other things.
Long said that even EPSDT should be considered minimal coverage, especially for children with asthma, Down syndrome, heart disease or other conditions.
Insurers say that children's coverage offered through the exchange will be broad enough andÂ that it isÂ an improvement for children who currently have no coverage or limited coverage.
Charles Bacci of the California Association of Health Plans said that if the 500,000 children expected to gain coverageÂ through the insurance exchange were guaranteed the best coverage, health care costs would increase dramatically.He said, "The more broad the benefit package, the moreÂ expensive your health care premiums are," adding, "The more narrow the benefit, the more affordable your premiums are" (Korry, "State of Health," KQED, 12/12). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.