Kusma Jennifer D, Raphael Jean L, Perrin James M, Hudak Mark L
Department of Pediatrics, Lurie Children's Hospital, Northwestern University School of Medicine, Chicago, Illinois.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Pediatrics. 2023 Nov 1;152(5). doi: 10.1542/peds.2023-064088.
The American Academy of Pediatrics envisions a child and adolescent health care system that provides individualized, family-centered, equitable, and comprehensive care that integrates with community resources to help each child and family achieve optimal growth, development, and well-being. All infants, children, adolescents, and young adults should have access to this system. Medicaid and the Children's Health Insurance Program (CHIP) provide critical support and foundation for this vision. Together, the programs currently serve about half of all children, many of whom are members of racial and ethnic minoritized populations or have complex medical conditions. Medicaid and CHIP have greatly improved the health and well-being of US infants, children, adolescents, and young adults. This statement reviews key program aspects and proposes both program reforms and enhancements to support a higher-quality, more comprehensive, family-oriented, and equitable system of care that increases access to services, reduces disparities, and improves health outcomes into adulthood. This statement recommends foundational changes in Medicaid and CHIP that can improve child health, achieve greater equity in health and health care, further dismantle structural racism within the programs, and reduce major state-by-state variations. The recommendations focus on (1) eligibility and duration of coverage; (2) standardization of covered services and quality of care; and (3) program financing and payment. In addition to proposed foundational changes in the Medicaid and CHIP program structure, the statement indicates stepwise, coordinated actions that regulation from the Centers for Medicare and Medicaid Services or federal legislation can accomplish in the shorter term. A separate technical report will address the origins and intents of the Medicaid and CHIP programs; the current state of the program including variations across states and payment structures; Medicaid for special populations; program innovations and waivers; and special Medicaid coverage and initiatives.
美国儿科学会设想建立一个儿童和青少年医疗保健系统，该系统能提供个性化、以家庭为中心、公平且全面的护理，并与社区资源相结合，以帮助每个儿童和家庭实现最佳的成长、发展和幸福。所有婴儿、儿童、青少年和青年都应能使用这一系统。医疗补助计划和儿童健康保险计划（CHIP）为这一愿景提供了关键支持和基础。目前，这两个计划共同为大约一半的儿童提供服务，其中许多儿童是少数族裔或有复杂医疗状况的人群。医疗补助计划和儿童健康保险计划极大地改善了美国婴儿、儿童、青少年和青年的健康与幸福。本声明回顾了这些计划的关键方面，并提出了计划改革和改进措施，以支持建立一个更高质量、更全面、以家庭为导向且公平的医疗保健系统，该系统能增加服务可及性、减少差异并改善成年后的健康结果。本声明建议对医疗补助计划和儿童健康保险计划进行根本性变革，以改善儿童健康、在健康和医疗保健方面实现更大公平、进一步消除计划中的结构性种族主义，并减少各州之间的重大差异。这些建议聚焦于：（1）资格和保险期限；（2）承保服务的标准化和护理质量；以及（3）计划融资和支付。除了提议对医疗补助计划和儿童健康保险计划的结构进行根本性变革外，本声明还指出了医疗保险和医疗补助服务中心的监管或联邦立法在短期内可以采取的逐步、协调行动。一份单独的技术报告将阐述医疗补助计划和儿童健康保险计划的起源和意图；该计划的现状，包括各州的差异和支付结构；特殊人群的医疗补助；计划创新和豁免；以及特殊医疗补助覆盖范围和举措。
