The American Academy of Pediatrics recognizes the achievements of the Medicaid program in improving access to health care services for poor children. Despite recent legislative expansions to extend eligibility to more poor and disabled children and to broaden the scope of preventive and treatment services in all states, several additional program improvements are needed to eliminate the following barriers to access:

1. Federal and state fiscal crises are creating major roadblocks to Medicaid program implementation and expansion.

2. Thousands of poor children will not be eligible for Medicaid until October 1, 2001.1

3. Only a portion of those who are potentially eligible for Medicaid apply for coverage, and many eligible children do not utilize services.

4. Fewer Medicaid funds are available for primary and preventive care because of the increasing need for long-term care services.

5. Early and periodic screening, diagnosis and treatment (EPSDT)/preventive health services are being received by too few children and the implementation of expanded service coverage under EPSDT, granted in 1989, is subject to a great deal of inconsistent state interpretation.

6. Inadequate provider reimbursement reduces children's access to health care services.

The Academy has developed the "Children First" proposal which calls for the elimination of Medicaid and replaces it with a one-class, private insurance system of universal access to health care for all children through age 21 and for all pregnant women.2 However, until the "Children First" proposal, or a similar health care reform initiative is implemented, the Academy recommends the following policy actions to improve the current Medicaid program.

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