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November 2016

Medicaid and Children’s Hospitals—A Vital but Strained Double Helix for Children’s Health Care

Author Affiliations
  • 1Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2Robert Wood Johnson Foundation Clinical Scholars, University of Michigan, Ann Arbor
JAMA Pediatr. 2016;170(11):1043-1045. doi:10.1001/jamapediatrics.2016.2328

Together, state Medicaid programs and children’s hospitals disproportionately contribute to care for children whose health is most vulnerable. Children’s hospitals look to Medicaid to provide coverage for an age group that does not enjoy an entitlement as broad as Medicare for seniors. Medicaid relies on children’s hospitals to provide age-specific, subspecialty-focused, technology-enriched care that is not as readily available in other health care institutions.

In essence, Medicaid and children’s hospitals form an indispensable double helix at the nucleus of health care for youth in the United States. Yet, there are tensions in this partnership. Central concerns revolve around expenditures: children’s hospitals often want higher Medicaid reimbursements, and state Medicaid programs sometimes argue that children’s hospitals are too expensive. Other points of friction include payment arrangements (fee-for-service vs managed care vs global payment) and leadership of care coordination (Medicaid health plans vs hospitals).

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