An examination of Pennsylvania's approach to Caring for Children with Special Healthcare Needs (CSHCN) and recommendations to improve access to needed services while controlling costs

As of 2011/2012 data, the population of Children with Special Health Care Needs (CSHCN) in the United States was 14,598,000 representing 20% of the population of children under age 18. In Pennsylvania, the percentage of CSHCN is above the National rate at 22%. The majority of funding to provide CSHCN with necessary health services and supports comes from Medicaid programs. State budgets are stretched and can’t keep pace with the growing need for services and are often faced with cutting benefits or limiting access. The public health relevance for addressing the increasing demand for access to appropriate healthcare services for CSHCN in Pennsylvania is that the Medicaid program is critical to the health and well-being of thousands of children and their families and without a potential redesign, will not be able to offer the same access and level of services that it does today. The Centers for Medicare and Medicaid (CMS) has provided states with broad flexibility to design their Medicaid programs to serve the unique needs of their population and they must take advantage of available program options to provide necessary services to all CSHCN while controlling costs. The purpose of this Essay is to educate readers on the options that states have to design their Medicaid programs to address the needs of CSHCN; to examine Pennsylvania’s current approach to its Medicaid program that serves CSHCN as well as two other state approaches; and to provide a set of recommendations for Pennsylvania to consider as redesign opportunities