Health Promotion

The goal of primary care pediatric includes heping families achieve optimal growth and development of children.This includes many activities such as growth and development as well as illness prevention.It is reasonable to recommend that the guidelines for all children should be applied in the presence of chronic illness.The medical management of the child with chronic illness is not the only component of care.There are many lifestyle and other non-medical considerations.Some of these components, such as good nutrition, need to be added and some, such as smoking and drugs, need to be avoided.Education is one of the major keys to health promotion.This needs to be included in the overall care plan and should be considered in the light of the family situation.The plan needs to be realistic and achievable, otherwise it will not be followed.It will need to be evaluated at each visit and reinforced as necessary.

A full range of preventive and therapeutic services are covered by Medicaid which include hospital care,physician and out-patient services, laboratory, and skilled nursing services.Some states include eye, dental, drugs, and home health care.Eligibility varies from states but the major criteria include receiving welfare or SSI.This may be through AFDC (Aid to Families with Dependent Children) which is dependent upon income relative to the poverty level.

An important program is the Early Periodic Screening Diagnosis and Treatment Program (EPSDT).This enables children who are eligible  for Medicaid to receive health screening and, if health problems are identified, the cost of diagnosis and treatment are covered.

Managed care programs associated with Medicaid may be more beneficial for children with chronic conditions that straight Medicaid.This is because there may be a wider range of services with better coordination of care; however, accses to specialists may not be as easy.

Children who are dependent on mechanical ventilation or other technologies may be eligible for home-care coverage under the Medicaid Model Home and Community Based Waiver.The purpose for the coverage is to provide home health nursing and services to reduce the need for continued hospitalization.This program should lead to considerable cost savings.

Supplemental Security Income (SSI), Title XVI of the Social Security Act, was extended in the 1976 to include children under 16 with disabilities.This is designed to help recipients to become as self-sufficient as possible.Although there is no direct payment of costs for medical care, the recipients are eligible for care under Medicaid which then helps pay for the medical care of the child with a chronic condition.

The requirement for eligibility are complex.The financial level is set at a level below the poverty line (in 1994 it was 74 percent) and dependent on the cash level of the applicant’s resources.