Public coverage provides vital safety net for children with special health care needs.

In 2003, an estimated 13.5 million American children had special health care needs, ranging from learning disorders to severe disabilities. Medicaid or the State Children's Health Insurance Program (SCHIP) covered nearly two out of five children with special health care needs, according to a new study by the Center for Studying Health System Change (HSC). Despite the critical safety net provided by public insurance to millions of special-needs children, an estimated 650,000 of these medically vulnerable children were uninsured in 2003. Many likely were eligible for public insurance but not enrolled. Among special-needs children, those with public and private coverage reported about equal rates of problems obtaining health care, indicating Medicaid and SCHIP provide access to care comparable to private insurance. Overall, children with special needs faced more access problems than other children, and their families reported more problems paying medical bills. Policy measures now under consideration, such as increased cost sharing in Medicaid and SCHIP, would likely increase access problems for children with special needs.