Health Care Reform and DSCCShriners Hospital for Children

October 2011

Division of Specialized Care for Children

Mission

Provide, promote and coordinate family-centered, community-based, culturally competent care for eligible

children with special health care needs (CSHCN) in Illinois

Organizational Structure

• University of Illinois - Chicago

• 13 Regional Offices• Serves all 102

Counties in Illinois

Regional OfficeCare Coordination Teams

• Nurses

• Social Workers

• Audiologists

• Speech-Language Pathologists

• Program Coordinator Assistants

Challenges for Families of CSHCN

• Families of CSHCN require multiple services from an array of providers.

• Services can be uncoordinated and fragmented.

• Families often need a link to and between these services.

• Families of children with special needs frequently need services to meet more than just the medical needs.

Challenges for Families of CSHCN

• Programs operate under different rules and eligibility requirements that can result in gaps and overlap in services.

• The system of care for children and families is confusing to both those needing services and those providing services.

• Health care resources are limited and insufficient to meet all needs.

• Some parents can’t do it all by themselves.

DSCC Core Program

Coordinating Care for CSHCN

Core Program

• Operates under Administrative Rules

• Has served over 1 million children since inception

• Serves about 17,000 CSHCN a year

Eligibility

General Eligibility• Age (birth to 21)• Residency• Citizenship

• Medical Eligibility• Impairment Category Specific

• Financial Eligibility• 285% FPL

Medically Eligible Conditions

Must have a treatable, chronic condition in the following categories:Orthopedic (bone, joint, muscle) Speech conditions requiring

medical/dental treatment

Heart defect Certain inborn metabolic problems (such as PKU, galactosemia)

Hearing loss Eye impairments ( including cataracts, strabismus and certain retinal conditions and excluding refractive errors)

Neurological Condition (nerve, brain spinal cord)

Urinary impairments (kidney, ureter, bladder)

Certain birth defects Cystic Fibrosis

Disfiguring defect (such as cleft lip/palate & severe burn scars)

Hemophilia

Care Coordination Services

• Uses a family-centered approach

• Conducts an assessment of needs

• Works with family to develop an Individualized Service Plan (ISP)

• Facilitates communication among specialists, medical home and community providers

Care Coordination Services

• Provides information about medical conditions, local resources

• Provides benefits management

• Assists with access to services, including educational resources

• Transition planning to move to adult services

Health Care Reform and DSCC

Health Care Reform – Full Access

• DSCC currently serves 3,000 financially eligible children with private Insurance• Provide Care Coordination • Help families to understand their insurance

i.e. benefit limitations and networks

Understand limits of Insurance

• Insurance may not adequately meet the needs of children/youth with special healthcare needs• Limit or exclusion of certain benefits• Medications• Ramps/Lifts• Hearing Aids• Orthodontia

DSCC as a Gap Filler

• Assists on items not covered

• Assists financially eligible families with insurance deductibles, co-payments, and co-insurance.

State Insurance Exchanges

• Help families find affordable Coverage*Connect families to the Illinois Health

Insurance Exchange

*Identify services most important for the child

*All Kids Application Agent

Contact DSCC

217-558-2350800-322-3722

FAX 217-558-0773TDD 217-785-4728

www.uic.edu/hsc/dscc