Issue Area: Children’s Access to Primary Health Care

1. Issue Area: Children’s Access to Primary Health Care What are the gaps in the provision of primary health care to children impacted by disasters, especially in geographic areas where the Federal government is providing on-going disaster recovery support and funding for other services? Of particular interest are health care worker shortages, health care-related community capacity building, and training of primary health care providers. • Desired State: • Ensure access to comprehensive physical and mental health services for all children during recovery from a disaster, ideally through a “medical home”, defined as a source of primary care that is accessible, continuous, and coordinated. • Accelerate the development of a National Disaster Recovery Strategy with an explicit emphasis on addressing the immediate and long term physical and mental health, educational, housing, and human services recovery needs of children. • Expand medical capabilities of all Federally funded response teams through comprehensive integration of pediatric-specific training, guidance, exercises, supplies, and personnel. • Barriers to the Desired State: • No reimbursement through the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) • Medicaid shortcomings when relocated • Centers for Medicare and Medicaid (CMS) Eligibility • Lack of electronic medical records • Lack of recovery planning at the state and local levels • Health care professional shortage

2. Issue Area: Children’s Access to Primary Health Care • Additional Barriers to the Desired State: • Lack of mechanisms for training health care professional both before and post-disaster • Lack of a coordinated system to manage credentialing and verify volunteers’ qualifications • Lack of mechanisms for sharing information, across organizations and states • Lack of tracking mechanisms, both for patient records and for families’ locations • Lack of both access to care and eligibility for a payer source (health insurance, Medicaid) when re-located to another state • Stafford Act does not provide reimbursement to for-profit PHC providers; difficult to repay SBA loans

3. Issue Area: Children’s Access to Primary Health Care • Additional Barriers to the Desired State: • Lack of single source of information for primary health care providers that would link them to sources of funding and support for rebuilding • Need for improved case management for children • Lack of incentives to bring in new PHC providers to disaster-affected areas • Variation in local emergency plans – lack of standards and coordination, lack of federal leadership and models • Need to address safety issues

4. Issue Area: Children’s Access to Primary Health Care • Recommendations for the Commission: • Access and Eligibility to Health Insurance • Need unified waiver policies across all Federal agencies – should improve portability of health insurance for children • Improve CMS through evaluation of access and eligibility • Need to educate states on CMS 1115 and 1135 waivers • Identify if there is a gap in the waivers for children with special health care needs

5. Issue Area: Children’s Access to Primary Health Care • Recommendations for the Commission: • Coordination • An in-depth review of the stakeholders must be involved in process of development of NDRF • Children must be integrated throughout NDRF, not in its own box • State and local recovery planning must be tied to funding (no “unfunded mandates) • Build capacity at local level for recovery – financial resources and staff • Recovery planning needs flexibility to include non-traditional approaches to recovery based on community needs

6. Recommendations for the Commission: • Training • Acute development of role-specific training for delivery of health care services and disaster recovery coordination. • Develop a curriculum and training clearinghouse of published literature and evidence-based research. Subject matter experts should provide input from beginning and performance measures for training should be established. • Community and family-based organizations should be included. Issue Area: Children’s Access to Primary Health Care

7. Recommendations for the Commission: • Critical Infrastructure • Change definition of critical infrastructure to include health care facilities, including for-profits, and provide appropriate funding stream • Create a recovery fund that is separate from disaster response funding (i.e. Stafford Act funding) • Create a mechanism in legislation that ensures supplemental funding for Medicaid • Integrate private sector of children’s health care into process of medical planning • Institutionalize and better utilize MRC and ESAR-VHP process at local level • Develop scalable, deployable federal medical assets that can be transferred permanently to rebuild local primary health care infrastructure Issue Area: Children’s Access to Primary Health Care

8. Issue Area: Children’s Access to Primary Health Care • Recommendations for the Commission: • Other • State planning should include planning for alternative care sites to provide on-going primary health care; these must meet minimum standards • Medicaid and insurance should follow individuals across state lines • Establish emergency catastrophic coverage for kids with automatic enrollment • Fund local/regional entities to conduct post-disaster needs assessment • Support establishment of telemedicine to improve access to pediatric expertise • Establish incentives for health care workers to stay or return to community • Promote citizen and community involvement in recovery planning before, during and after disasters