Access to Affordable, High-Quality Pediatric Care

Medicaid and the Children’s Health Insurance Program (CHIP) provide essential healthcare coverage for more than 80 million individuals and families, including over 40% of all children in the United States. CHOP is committed to preserving and enhancing these safety net programs, which benefit our patients and play a crucial role in reducing healthcare disparities.

If you are interested in learning more about Medicaid and CHIP, check out: Georgetown’s Center for Children and Families’ Medicaid Learning Lab. If you’re a family seeking help enrolling in Medicaid or CHIP, please reach out to CHOP’s Family Health Coverage Program.

Reducing barriers to pediatric care for New Jersey children with Medicaid

Children enrolled in New Jersey Medicaid should have access to the comprehensive and integrated pediatric care they need. There should be no barriers to children getting necessary care, regardless of income. For that reason, we have aggressively pursued in-network agreements with every New Jersey Medicaid managed care plan. At this moment, no NJ Medicaid plan has CHOP in-network. This has a disproportionate impact on children with disabilities and medical complexities seeking the care they need.

In 2021, CHOP put out an advocacy call to action to our employees, patients and community resulting in over 6,000 emails to the NJ legislature supporting passage of legislative solution to ensure that all of New Jersey’s kids who have Medicaid managed health plans have in-network access to pediatric specialists within easy distance of their homes.

This legislation is now law, and CHOP continues to advocate during its implementation phase with the NJ Department of Human Services. This was a groundbreaking achievement, and also a prime example of government process taking time, as we continue to advocate during the implementation phase.

Pharmaceutical access and pricing

CHOP monitors several issues related to pharmaceutical pricing and access for children. There are government programs that help provide lifesaving outpatient medications at discounted rates to safety net providers, including children’s hospitals. CHOP also continues to actively explore other ways to make access to life-saving medications, such as insulin and albuterol, more affordable for patients.

Reforming the prior authorization process in Pennsylvania to support patients’ timely access to care

CHOP collaborated with advocates to advance the passage of this law, which streamlines authorization processes in healthcare settings that reduce delays in medically necessary care for patients, no matter what insurance they may have.

Expedited partner therapy

CHOP partnered with local advocates, including Access Matters, to advance the Expedited Partner Therapy Act. This law, passed by the legislature and signed by Gov. Tom Wolf, will help reduce barriers and increase access to expedited partner therapy (EPT), an evidence-based, cost-effective method of reducing community spread of sexually transmitted infections (STIs) by removing barriers to care. If you’re interested in learning more about EPT, check out PolicyLab’s issue brief for more information.