Medically Complex Children

August 23, 2022

Priority:   Work with SC DHHS to improve services and care coordination for children with medical complexity, most of whom rely upon Medicaid for coverage.

Background:  ACE Kids Act, the Advancing Care for Exceptional Children, was signed into law by Congress as part of the Medicaid Services Investment and Accountability Act of 2019.    Designed to address challenges in receiving care, the law gives state Medicaid programs the option and flexibility to create specialized medical homes for children with medical complexity.   An estimated three million children in the United States are medically complex.  A three-year pilot project to study care coordination models for children with medical complexity was funded by the Center for Medicare and Medicaid (CMMI). (2015 – 2018) Known as the CARE Award, the project involved ten children’s hospitals across the country, eight state Medicaid programs, and more than 8,000 medically complex children.  Results released in 2018 demonstrated a 32% decrease in inpatient days, a 26% decrease in emergency department visits, and a 3% overall decrease in spending.