Financing health services for children in Texas.

In Texas, children's health services are financed by a bewildering combination of private and public sources, each of which employs different eligibility rules, benefit packages, and reimbursement methods. This article describes these financing mechanisms, underscoring their complexity and the need for consolidation and reform. As private coverage for children has declined, it has become less comprehensive with increased coinsurance and deductibles. Concurrently, due to a number of federal initiatives, Medicaid coverage has increased rapidly with new benefits, also now mandated. Levels and structure of payment have influenced variable participation in the program by physicians, rural health clinics, federally qualified health centers, and children's hospitals. The Texas Department of Health and the Texas Department of Mental Health and Mental Retardation have undertaken a number of initiatives to fill in the gaps and to serve mandated categorically eligible populations. Continuity of care is difficult to achieve. Comprehensive community-based care should be promoted with the goal of expanding the role of all types of providers.