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Charleston, SC 29425
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July 2008
Pediatric Advocacy: Building Bridges
Politics and children's healthcare - at first glance, the two seem unrelated. Yet the funding of children's healthcare is largely driven by the legislative process - making it very political. Funding for the state's Medicaid program, the children's health insurance program, and many other children's services is appropriated each year by the legislature. Children have no "legislative voice," and legislators, although well meaning, struggle with multiple priorities.
Making children's health issues a legislative priority is just one of the multiple functions performed by the MUSC Center for Child Advocacy.
"It's challenging - the average legislator doesn't have a lot of knowledge about these (children's healthcare) programs," says Charles P. Darby Jr., MD, "There are so many competing needs. It is a constant battle for us to move these items up the priority list. There is a long list of groups and organizations fighting for state funds. We just have to convince them that children deserve a good shake."
And convince them he has. A longtime advocate for children, Dr. Darby's "career" in advocacy began, some would say, when he successfully obtained state funds to build MUSC Children's Hospital. His efforts continue today in his role as the executive director of the Center for Child Advocacy, formed in 2001. The Center for Child Advocacy (CCA) works to provide a variety of government relations, advocacy, Medicaid, service development, and outreach services in support of the MUSC Children's Hospital.
CCA also manages the South Carolina Children's Hospital Collaborative, a non-profit organization made up of the four children's hospitals in South Carolina. "Protecting some of these programs for children is especially difficult right now, when people are concerned with just staying afloat," notes Dr. Darby. "When the economy turns down, there's less consumer spending, less sales tax, less state income - less money for these programs."
Looking out for the little ones
In recent years, Dr. Darby and the CCA have successfully advocated for the following:
- Enhanced Medicaid reimbursement for pediatric specialists. Having adequate reimbursement is critical to providing services. And, notes Dr. Darby, "this gives children access to the best specialists."
- The development and implementation of a statewide forensic medical response system for children who are suspected victims of child abuse. This system, known as the
South Carolina Children's Advocacy Medical Response System (SCCAMRS) has dramatically improved the quality and quantity of pediatric forensic medical services in the state. "It's not an easy or inexpensive specialty - it requires photographs, X-rays, lengthy interviews, and often court and mediation," notes Dr. Darby.
- Expansion of the state children's health insurance program (SCHIP). CCA worked in partnership with many organizations and legislators to expand health insurance coverage to children in low- income families. Vetoed by the governor and subsequently overridden by the legislature, the expansion is expected to provide health insurance to 80,000 children. "We were pleased that the legislature had the wisdom and courage to override the governor's veto on SCHIP," comments Dr. Darby.
The wheels on the bus go round and round: work continues
The federal government matches every state dollar spent on Medicaid with three dollars. Likewise, the federal government matches every state dollar spent on SCHIP with four dollars. So it doesn't make economic sense to reduce state funding, explains Dr. Darby, especially when you consider that the healthcare will still be provided. "We try to get them to spare Medicaid. We have to keep our hospitals and our emergency rooms open, and we won't turn a child away. The state ends up paying for these services, and it costs them more without the federal matching funds."
Initiatives for the coming year include:
- State funding for the three developmental evaluation centers (DECs), which face closure due to impending changes in Medicaid reimbursement. Children are referred to a DEC for a multidisciplinary evaluation of a suspected developmental or behavioral disorder. An accurate diagnosis is essential in identifying appropriate early intervention services.
- An increase in the cigarette tax. Unlike adults, children are more price-sensitive to the cost of cigarettes. The number of children smoking generally decreases as the price of cigarettes increases. "In addition, we'd like to expand the SCHIP program and cover more uninsured children," says Dr. Darby.
- Preserve funding for the SCHIP program and move its legislative language into permanent law.
- Work with Medicaid to preserve and restructure the state's three medically fragile children's programs, facing possible closure pursuant to changes in federal policy. These programs serve medically fragile children, providing all needed services in one setting. "It's very cost effective," explains Dr. Darby.
- State funding for the South Carolina Children's Advocacy Medical Response System.
Advocacy is the bridge that connects the disparate worlds of children's healthcare and politics. The MUSC Center for Child Advocacy, in partnership with the South Carolina Children's Hospital Collaborative will always have more "bridges to build".
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