The American Academy of Pediatrics recognizes the achievements of the Medicaid program in reducing financial barriers to health care for poor children; however, the legislative intent of the program has yet to be fully achieved.

An administrative structure focused on ensuring access to acute care and long-term care has allowed vital preventive care for children to languish while program expenditures have soared.

Confusing eligibility requirements have eliminated many of the neediest children from program participation.

State discretion in covered services has resulted in major disparities among geographical areas, leaving many eligible children with inadequate care.

The American Academy of Pediatrics in its desire to uphold the quality of children's care and in accordance with its standards seeks to remedy this situation. The following specific proposals are the minimum provisions that the Medicaid program should include for its child beneficiaries.

I. Eligibility

A. The sole determinant of program eligibility for children should be financial need. Categorical requirements, eg, only children from single-parent families, should be eliminated from eligibility criteria.

B. The means test for children should include limits on readily disposable assets and an income standard at least equal to the federal poverty line.

1. The income standard could be adjusted to reflect geographical differences and should be recalculated annually to reflect changes in the federal poverty income standard.

2. "Spend-down" provisions for children in families whose income before medical expenses exceed the eligibility limit should be continued.

C. Automatic eligibility of unborn and newborn children should be included as long as the child's family meets the means test requirements.

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