Bipartisan Bills Would Let Severely Ill Medicaid Kids Get Out-Of-State Care

Legislation to ease Medicaid coverage in other states for children with complex conditions has captured bipartisan support in Congress, but could fall victim to Obamacare politics.

The legislation, Advancing Care for Exceptional Kids Act of 2015 (S-298 and H.R. 546), is supported by the Children's Hospital Association. 

It seeks to reduce problems that beneficiaries of Medicaid and the Children's Health Insurance Program—such as children with complex illnesses and disorders like leukemia and muscular dystrophy—sometimes encounter when they seek access to care across state lines. Since Medicaid and CHIP are state-based programs, non-emergency procedures tend to only be covered if they are provided within the state. 

Under the ACE Kids Act, once a state volunteers for the initiative, eligible children would be assigned to a nationally designated children's hospital network. These networks would coordinate the full range of services these children need, including home, primary-, ambulatory-, acute- and post-acute care providers. Even with the states opting into the national framework, each participating state would continue to set payment rates, benefits and enrollment.

Ford O'Connell, a Republican strategist, said the ACE Act has a good chance of becoming law if it actually would improve healthcare services for children and save money. “But the devil is in the details. How exactly will it do what it claims to do?” he said. 

Read more from Virgil Dickson at Modern Healthcare

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Analysis & Political Strategy