Medicaid Transitions for Youth with Special Health Care Needs Face Coverage and Benefit Gaps
Medicaid covers nearly half of all children and youth with special health care needs (CYSHCN), but when they age out of children's Medicaid and transition to adult coverage, they face significant changes to benefits, provider networks, and care coordination. These transitions can result in coverage gaps and disruptions in medically necessary services. The challenges are particularly acute for youth who rely on pediatric specialists, EPSDT benefits, and care coordination programs that do not continue into adult Medicaid. State Medicaid agencies and managed care organizations must address transition planning, benefit continuity, and provider capacity to support this population.
Managed care organizations and state Medicaid agencies must develop transition protocols and ensure adequate adult provider networks to prevent costly gaps in care and avoidable emergency department utilization for a high-need population aging into adult coverage.
LTSS · Managed Care
You might also like