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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