Pediatric Medical Necessity: EPSDT, CHIP, and Children’s Health Coverage in the Era of Health Reform
This state-only webinar presented by NASHP with support from the Commonwealth Fund and the David and Lucile Packard Foundation for EPSDT and CHIP program administrators provided participants with an opportunity to learn more about the concept and legal definitions of pediatric medical necessity and to talk with their peers about implementation of pediatric necessity within Medicaid/EPSDT and CHIP programs. It also addressed working with stakeholders to develop the pediatric medical necessity definition.
Moderated by Neva Kaye, Senior Program Director, and Catherine Hess, Senior Program Director, National Academy for State Health Policy.
Agenda
The speakers were:
- Anne Markus, PhD, JD, Assistant Dean for Academic Affairs and Associate Professor of Health Policy at George Washington University
A Legal and Policy Overview on Pediatric Medical Necessity - Cathy Caldwell, Director of the Bureau for Children’s Health Insurance in the Alabama Department of Public Health
Pediatric Medical Necessity and CHIP
- Marti Cote, RN, Social Services Program Specialist at the Nevada Division of Health Care Financing and Policy
Lessons from Nevada
- David Kelly, MD, MPA, Medical Director of the Pennsylvania Office of Medical Assistance Programs
Pediatric Medical Necessity in EPSDT
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
