Threading the labyrinth: why children in California with special health care needs endure delays in securing the medical equipment and supplies they need
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report (Lucile Packard Foundation for Children's Health)
- Author(s):
- O'Sullivan, Maryann, author Tompkins, Francis, author
- Contributor(s):
- Lucile Packard Foundation for Children's Health, issuing body.
- Publication:
- Palo Alto, CA : Lucile Packard Foundation for Children's Health, May 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Services Disabled Children Durable Medical Equipment Health Services Accessibility Health Services Needs and Demand Child Health Care Surveys Insurance, Health, Reimbursement Managed Care Programs Medicaid Parents State Government Humans California United States
- Genre(s):
- Technical Report
- Abstract:
- Approximately 200,000 children with serious medical conditions receive health coverage through the California Children's Services (CCS) program, whose responsibilities include ensuring that these children are provided with the medically necessary durable medical equipment (DME) and supplies that they require. Although data are scant, three recent surveys point to frequent long delays in obtaining equipment and supplies. In a 2017 survey of families, 22% of respondents reported waiting a year or more for needed equipment and supplies, and an additional 16% mentioned having cases that were unresolved. Despite such delays, the state has not identified required time frames for getting medically necessary equipment and supplies to children in the CCS program. Children suffer when medical equipment and supply deliveries are delayed. Parents report that long delays distract them from caring for their children, cause unnecessary developmental delays, and increase physical pain and suffering. What are the reasons behind these chronic delays, and what can be done to address them? The author of this report conducted dozens of interviews, including with CCS medical therapists, nurses, physicians, and administrators, vendors, Regional Center and Medi-Cal managed care health plan staff, state officials, advocates, parents, and others. The goal was to understand the administrative obstacles that contribute to delays in obtaining essential supplies and equipment such as wheelchairs, walkers, ventilators, leg braces, and hospital beds. This report identifies the issues--including payer priority/payer of last resort disputes and CCS internal and vendor-related barriers--that underlie administrative delays. It also highlights promising practices that some counties are engaging in to mitigate delays. The author offers a set of state- and county-level policy recommendations that address multiple issues underlying the delays. While some of these recommendations may be initiated at the local level, by and large the state should establish standardized requirements, monitor and enforce policies, and provide support to localities as they implement new approaches. In light of the devastating impact the delays have on children, and in light of the impending implementation of the Whole-Child Model, policymakers should move forward with a sense of urgency to implement these recommendations. One or more legislative informational hearings would provide an appropriate forum to support information gathering to address how best to move forward to enact these recommendations.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (42 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101744823 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101744823