child care - Digital Library Collections
child care - Digital Library Collections child care - Digital Library Collections
THE STATE OF AMERICA'S CHILDREN YEARBOOK 1998 • Improving Medicaid managed care. The federal government should ensure that the Balanced Budget Act provisions that apply to Medicaid managed care are implemented in ways that promote the best possible care for families. States should hold managed care plans accountable for providing high-quality, accessible services appropriate to the unique health requirements of children and teens, including those with special needs. States should supplement regulatory safeguards with incentives for managed care plans to provide good care. For example, to reward a managed care organization with a superior track record of providing well-child visits and immunizations, a state could assign it a significantly larger share of the Medicaid families who, after receiving ample notice and opportunity to act, fail to choose a health plan themselves. • Strengthening protections for children in private managed care plans. Both Congress and state legislatures should enact enforceable standards to ensure that private managed care organizations provide consumers with good information and accessible, high-quality care that addresses the unique health care needs of children and teens. • Encouraging voluntary efforts by managed care plans. All managed care plans-those serving Medicaid and CHIP children as well as those covering only privately insured children-must make a concerted effort to give better care to children and teens. This means ensuring good access to the full range of necessary services for young people, ranging from well-child care and home health visits to ongoing benefits for children with special health care needs. • Improving maternal and child health. Federal, state, local, and private entities must continue their efforts to increase immunizations, reduce infant mortality, and address other pressing health problems of children and teens, such as asthma and sexually transmitted diseases (including AIDS). Special attention must be given to children with disabilities and to low-income and minority children, who are disproportionately likely to suffer poor health. As states increase children's health coverage through the new CHIP program, they must expand coverage for pregnant women as well. • Maintaining employer health coverage. Employers should stop eliminating coverage for children from their employees' health benefits or paying a smaller and smaller share of premiums for family health coverage. When more health insurance costs are shifted to workers, more children and families become uninsured. Campaigns directed at improving wages and other employer support for families should encourage the public and private sectors to consider companies' health coverage when selecting contractors and vendors. Contracts should be restricted to companies that pay a substantial proportion of their workers' family insurance costs, provide comprehensive health insurance benefits, and limit out-of-pocket costs for employees and their families. 36 CHI L D R EN'S D E FEN S E FUN D
CHAPTER CHILD CARE ood-quality child care and early education programs are essential for millions of American families. Thirteen million preschool children-including 6 million infants and toddlers-spend all or part of their day being cared for by someone other than their parents. In addition, millions of school-age children need supervision during the hours when their parents are at work and their schools are closed. Many parents, however, are hard pressed to fmd affordable, reliable child care that gives them peace of mind about their children while they work. The number of parents for whom adequate child care is a constant concern has grown dramatically over the past 25 years. In 1973 approximately 30 percent of mothers with children under age 6 were in the work force, as were more than 50 percent of mothers of school-age children. By 1997 these percentages had grown to 65 percent and 77 percent, respectively (see table 3.1). As recent changes in the welfare laws compel recipients of government assistance to work, the numbers will keep climbing. In addition, because income is declining for youn~ families (see chapter I), many simply cannot make ends meet unless both parents work. About half ofAmerica's families with young children earn less than $35,000 per year, and the Families and Work Institute reports that the majority ofworking women provide half or more of their household income. More than ever, American families desperately need child care that is affordable and of high quality. Child Care: 1973 to 1998 Families in 1973 found little help from either the government or the private sector as they searched for child care that would enable them to work and ensure their children's safety and wellbeing. President Nixon had just vetoed the 1971 Comprehensive Child Development Act, which would have provided $2 billion to help states and local communities expand and improve families' access to quality child care. Head Start, now a widely acclaimed early childhood development program, was a relatively new initiative serving 379,000 low-income children-many in summer programs only. The federal government provided only limited funds for child care services, primarily for families receiving welfare. CHILDREN'S DEFENSE FUND 37
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THE STATE OF AMERICA'S CHILDREN YEARBOOK 1998<br />
• Improving Medicaid managed <strong>care</strong>. The federal<br />
government should ensure that the Balanced<br />
Budget Act provisions that apply to Medicaid<br />
managed <strong>care</strong> are implemented in ways that<br />
promote the best possible <strong>care</strong> for families.<br />
States should hold managed <strong>care</strong> plans accountable<br />
for providing high-quality, accessible<br />
services appropriate to the unique health requirements<br />
of <strong>child</strong>ren and teens, including<br />
those with special needs. States should supplement<br />
regulatory safeguards with incentives for<br />
managed <strong>care</strong> plans to provide good <strong>care</strong>. For<br />
example, to reward a managed <strong>care</strong> organization<br />
with a superior track record of providing<br />
well-<strong>child</strong> visits and immunizations, a state<br />
could assign it a significantly larger share of<br />
the Medicaid families who, after receiving ample<br />
notice and opportunity to act, fail to<br />
choose a health plan themselves.<br />
• Strengthening protections for <strong>child</strong>ren in private<br />
managed <strong>care</strong> plans. Both Congress and state<br />
legislatures should enact enforceable standards<br />
to ensure that private managed <strong>care</strong> organizations<br />
provide consumers with good information<br />
and accessible, high-quality <strong>care</strong> that addresses<br />
the unique health <strong>care</strong> needs of<br />
<strong>child</strong>ren and teens.<br />
• Encouraging voluntary efforts by managed <strong>care</strong><br />
plans. All managed <strong>care</strong> plans-those serving<br />
Medicaid and CHIP <strong>child</strong>ren as well as those<br />
covering only privately insured <strong>child</strong>ren-must<br />
make a concerted effort to give better <strong>care</strong> to<br />
<strong>child</strong>ren and teens. This means ensuring good<br />
access to the full range of necessary services<br />
for young people, ranging from well-<strong>child</strong> <strong>care</strong><br />
and home health visits to ongoing benefits for<br />
<strong>child</strong>ren with special health <strong>care</strong> needs.<br />
• Improving maternal and <strong>child</strong> health. Federal,<br />
state, local, and private entities must continue<br />
their efforts to increase immunizations,<br />
reduce infant mortality, and address other<br />
pressing health problems of <strong>child</strong>ren and<br />
teens, such as asthma and sexually transmitted<br />
diseases (including AIDS). Special attention<br />
must be given to <strong>child</strong>ren with disabilities<br />
and to low-income and minority <strong>child</strong>ren,<br />
who are disproportionately likely to suffer<br />
poor health. As states increase <strong>child</strong>ren's<br />
health coverage through the new CHIP program,<br />
they must expand coverage for pregnant<br />
women as well.<br />
• Maintaining employer health coverage. Employers<br />
should stop eliminating coverage for <strong>child</strong>ren<br />
from their employees' health benefits or<br />
paying a smaller and smaller share of premiums<br />
for family health coverage. When more<br />
health insurance costs are shifted to workers,<br />
more <strong>child</strong>ren and families become uninsured.<br />
Campaigns directed at improving wages and<br />
other employer support for families should encourage<br />
the public and private sectors to consider<br />
companies' health coverage when selecting<br />
contractors and vendors. Contracts should<br />
be restricted to companies that pay a substantial<br />
proportion of their workers' family insurance<br />
costs, provide comprehensive health insurance<br />
benefits, and limit out-of-pocket costs<br />
for employees and their families.<br />
36 CHI L D R EN'S D E FEN S E FUN D