Transition Services
Many states struggle with the challenge of funding the transition of youth with special health care needs (YSHCN) from pediatric to adult health care. Some of the burden of funding health care services for youth in transition has been alleviated with the passage of the Affordable Care Act, which allows young people to remain on their parents’ health insurance coverage through the age of 26, regardless of their student status. This may make a real difference for many young people who would otherwise be uninsured, but private insurance still leaves many financing gaps for youth with special health care needs, including care coordination or limitations on mental health care, durable medical equipment, and therapies. State Title V programs often play an important role in connecting youth with special health care needs to information, services, medical homes and other resources during the transition period, and some programs pick up some of the service costs for uninsured or underinsured children. Several states, including Mississippi, Nebraska, Nevada, New York, and Texas are testing new models of care or new financing systems.
Mississippi provides funding for a program at one central multi-specialty clinic and 14 satellite clinics to transition YSHCN, beginning at age 14, into adult care.
Nevada has a transition program that operates through the School of Medicine at the University of Nevada. It provides care coordination and family-centered supports with funding from grants.
New York has taken a different approach to transition services, offering a Medicaid buy-in program for individuals with disabilities between the ages of 16 and 64. Under the Ticket to Work and Work Incentive Act, many states have implemented these programs to allow adults with disabilities to work and still purchase Medicaid benefits. However, the New York program may be unique in that it begins at age 16. Individuals may have up to $10,000 in assets and incomes as high as 250% of FPL and be eligible for the program. Individuals with income that is at least 150% but at or below 250% of the FPL must pay a premium based on a sliding scale.
The Texas Title V program is establishing relationships with adult Independent Living Centers (ILCs) to help youth with the transition process and services. The state provides funding to connect youth with ILC conferences and to ensure that medical home pilot practices understand the importance of transition and commit to pursuing transition best practices.
