Crossing the medicaid-private insurance divide: The case of EPSDT

Health Affairs

Volumn 26, Issue 2, 2007, Pages 382-393

  Rosenbaum, Sara ^a   Wise, Paul H ^b  

^a GEORGE WASHINGTON UNIVERSITY   (United States)

^b STANFORD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD; CHILD HEALTH CARE; CHILD WELFARE; ECONOMICS; FEMALE; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; LEGAL ASPECT; MALE; MANAGEMENT; MEDICAID; NEEDS ASSESSMENT; POVERTY; PRESCHOOL CHILD; SOCIAL SECURITY; UNITED STATES;

AID TO FAMILIES WITH DEPENDENT CHILDREN; CHILD; CHILD HEALTH SERVICES; CHILD WELFARE; CHILD, PRESCHOOL; FEMALE; HEALTH CARE REFORM; HUMANS; MALE; MEDICAID; NEEDS ASSESSMENT; POLICY MAKING; POVERTY; STATE HEALTH PLANS; UNITED STATES;

EID: 33947311822     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.2.382     Document Type: Article

References (46)

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2. R. Stevens and R. Stevens, Welfare Medicine in America: A Case Study of Medicaid (New York: Free Press, 1975).
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4. Children's Defense Fund, EPSDT: Does It Spell Health Care for Poor Children? (Washington: CDF, 1977);
5. and S. Rosenbaum et al., "National Security and U.S. Child Health Policy: The Origins and Continuing Role of Medicaid and EPSDT," Policy Brief, June 2006, http://www.gwumc.edu/sphhs/healthpolicy/chsrp/downloads/ mil_prep042605.pdf (accessed 29 January 2007).
6. Sec. 1905(a)(4)(B), added by sec. 302(a), P.L. 90-248.
7. CDF, EPSDT: Does It Spell Health Care for Poor Children?
8. See Westside Mothers v. Haveman, 289 F. 3d 682 (6th Cir., 2002); and Frew v. Hawkins, 540 U.S. 541 (2004).
9. 42 U.S. Code, sec. 1396r.
10. Ibid.
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14. Institute of Medicine, From Neurons to Neighborhoods (Washington: National Academies Press, 2000);
15. Wise, "The Transformation of Child Health"; and Halfon and Hochstein, "Life Course Health Development."
16. IOM, From Neurons to Neighborhoods.
17. See National Welfare Rights Organization v. Richardson, 334 F. Supp. 488 (D.D.C., 1971); and Title III, P.L. 97-35.
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21. Ibid.
22. M. Broaddus and E. Park, "SCHIP Financing Update: In 2007, Seventeen States Will Face Federal Funding Shortfalls of $800 Million in Their SCHIP Programs," 28 November 2006, http://www.cbpp.org/6-5-06health2.htm (accessed 8 December 2006).
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24. Social Security Amendments, sec. 1937, added by Title V, P.L. 109-171.
25. R. Pear, "White House to Ease Medicaid Rule on Proof of Citizenship," New York Times, 7 July 2006.
26. National Governors Association, "Testimony by NGA Executive Director Ray Scheppach before the Medicaid Advisory Commission on Short-Term Medicaid Reform" (Washington: NGA, 17 August 2005);
27. and National Conference of State Legislatures, "NCSL Principles for Medicaid Reform," 19 August 2005, http://www.ncsl.org/statefed/health// MArefPrinc.htm (accessed 25 January 2007).
28. H. Rep. 109-276 sec. 1932(a).
29. Letter to Sec. Mike Leavitt from Sen.Charles Grassley (R-IA) and Rep. Joe Barton (R-TX), 29 March 2006.
30. CMS, State Medicaid Directors Letter 06-008, 31 March 2006, http://www.cms.hhs.gov/smdl/downloads/SMD06008.pdf (accessed 19 August 2006).
31. J. Solomon, "West Virginia's Medicaid Changes Unlikely to Reduce State Costs or Improve Beneficiaries' Health," 31 May 2006, http://www.cbpp.org/5-31-06health.htm (accessed 5 November 2006).
32. A. Schneider, "Tennessee's New 'Medically Necessary' Standard: Uncovering the Insured?" July 2004, http://www.kff.org/medicaid/7139.cfm (accessed 8 December 2006).
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34. S. Rosenbaum et al., The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations under State Health Insurance Laws, July 2003, http://www.gwumc.edu/sphhs/healthpolicy/immunization/reports.html (accessed 8 December 2006).
35. See Jones v. Kodak Medical Assistance Plan, 169 F. 3d 1287 (10th Cir., 1999);
36. and S. Rosenbaum et al., Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts, 4th ed. (online), 2003, http://www.gwumc.edu/sphhs/healthpolicy/nnhs4/ (accessed 8 December 2006).
37. J. Yegian, "Setting Priorities in Medical Care through Benefit Design and Medical Management," Health Affairs 23 (2004): w300-w304 (published online 19 May 2004; 10.1377/hlthaff.w4.300).
38. T. Baker and J. Simon, eds., Embracing Risk: The Changing Culture of Insurance and Responsibility (Chicago: University of Chicago Press, 2001).
39. Yegian, "Setting Priorities in Medical Care."
40. Bedrick v. Travelers Insurance Co., 93 F. 3d 149 (4th Cir., 1996).
41. C.E. Medill et al., "How Readable Are Summary Plan Descriptions for Health Care Plans?" EBRI Notes 27, no. 10, October 2006, http://www.ebri.org/pdf/notespdf/EBRI_Notes_10-20061.pdf (accessed 11 December 2006);
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43. L.A. Bergthold, "Medical Necessity: Do We Need It?" Health Affairs 14, no. 4 (1995): 180-190;
44. and S.J. Singer and L.A. Bergthold, "Prospects for Improved Decision Making about Medical Necessity," Health Affairs 20, no. 1 (2001): 200-206.
45. Commonwealth Fund, EPSDT and Children's Coverage Costs, September 2005, http://www.cmwf.org/publications/publications_show.htm?doc_id=358425 (accessed 8 December 2006).
46. Kaiser Commission on Medicaid and the Uninsured, "Medicaid: A Lower-Cost Approach to Serving a High-Cost Population," March 2004, http://www.kff.org/medicaid/7057a.cfm (accessed 29 December 2006).