1. Health Care Reform and DSCC Shriners Hospital for Children October 2011 Division of Specialized Care for Children

2. Mission Provide, promote and coordinate family-centered, community-based, culturally competent care for eligible children with special health care needs (CSHCN) in Illinois

3. Organizational Structure University of Illinois - Chicago 13 Regional Offices Serves all 102 Counties in Illinois

4. Regional Office Care Coordination Teams Nurses Social Workers Audiologists Speech-Language Pathologists Program Coordinator Assistants

5. Challenges for Families of CSHCN Families of CSHCN require multiple services from an array of providers. Services can be uncoordinated and fragmented. Families often need a link to and between these services. Families of children with special needs frequently need services to meet more than just the medical needs.

6. Challenges for Families of CSHCN Programs operate under different rules and eligibility requirements that can result in gaps and overlap in services. The system of care for children and families is confusing to both those needing services and those providing services. Health care resources are limited and insufficient to meet all needs. Some parents can’t do it all by themselves.

7. DSCC Core Program Coordinating Care for CSHCN

8. Core Program Operates under Administrative Rules Has served over 1 million children since inception Serves about 17,000 CSHCN a year

9. Eligibility General Eligibility Age (birth to 21) Residency Citizenship Medical Eligibility Impairment Category Specific Financial Eligibility 285% FPL

10. Medically Eligible Conditions Must have a treatable, chronic condition in the following categories: Orthopedic (bone, joint, muscle) Speech conditions requiring medical/dental treatment Heart defectCertain inborn metabolic problems (such as PKU, galactosemia) Hearing lossEye impairments ( including cataracts, strabismus and certain retinal conditions and excluding refractive errors) Neurological Condition (nerve, brain spinal cord) Urinary impairments (kidney, ureter, bladder) Certain birth defectsCystic Fibrosis Disfiguring defect (such as cleft lip/palate & severe burn scars) Hemophilia

11. Care Coordination Services Uses a family-centered approach Conducts an assessment of needs Works with family to develop an Individualized Service Plan (ISP) Facilitates communication among specialists, medical home and community providers

12. Care Coordination Services Provides information about medical conditions, local resources Provides benefits management Assists with access to services, including educational resources Transition planning to move to adult services

13. Health Care Reform and DSCC Health Care Reform – Full Access DSCC currently serves 3,000 financially eligible children with private Insurance Provide Care Coordination Help families to understand their insurance i.e. benefit limitations and networks

14. Understand limits of Insurance Insurance may not adequately meet the needs of children/youth with special healthcare needs Limit or exclusion of certain benefits Medications Ramps/Lifts Hearing Aids Orthodontia

15. DSCC as a Gap Filler Assists on items not covered Assists financially eligible families with insurance deductibles, co-payments, and co-insurance.

16. State Insurance Exchanges Help families find affordable Coverage *Connect families to the Illinois Health Insurance Exchange *Identify services most important for the child *All Kids Application Agent

17. Contact DSCC 217-558-2350 800-322-3722 FAX 217-558-0773 TDD 217-785-4728 www.uic.edu/hsc/dscc www.uic.edu/hsc/dscc