The National Center on Financing for CSHCN was created from a cooperative agreement between the Maternal and Child Health Bureau (MCHB) and the Institute for Child Health Policy at the University of Florida. The Center provides technical assistance to four different states and five public and private health plans. Their assistance concerns such matters as: (a) health-based risk adjustment strategies for plan and provider reimbursement; (b) financial incentive programs linking enhanced payments to realized quality of care measures; and (c) focused assessments of health plan performance related to care of CSHCN.

The purpose of this four year project is to work in support of the Maternal and Child Health Bureau to meet its Children with Special Health Care Needs (CSHCN) National Agenda performance outcome that “all families of CSHCN will have adequate private and/or public insurance to pay for the services they need.” The work of the cooperative agreement will be multi-faceted and will (1) overcome the gaps in knowledge about CSHCN’s health care use and charges, (2) assess the extent to which CSHCN are receiving the health care services they need and the degree to which reimbursement is adequate to meet those needs, (3) identify trends in and developing recommendations for financing strategies, and (4) disseminate this information to families, health care providers, public and private health plans, and policy makers.

Current work includes:

(1) an examination of current Medicaid and SCHIP financing and reimbursement strategies to determine their applicability to CSHCN using national data and person-level claims and encounter data and policy recommendations about the best combination of strategies to use when reimbursing health plans caring for CSHCN;

(2) an assessment of how financing strategies affect health plans of different sizes and the enrollment of children with different health care needs;

(3) the design of financing strategies for children newly enrolling in health plans;

(4) the development of financing strategies for children who are required to transfer to a new health plan when their previous plan exits the market;

(5) the design of financing strategies to promote the medical home concept and to reimburse providers caring for CSHCN;

(6) the impact of increased cost-sharing on children’s health care use patterns, families’ out-of-pocket spending, and children’s insurance status; and

(7) beginning analyses of health care use patterns and expenditures for adolescents with special needs who are transitioning to the adult health care system.