Issues and Advocacy

CHAT Support Letter to Chairman Burgess on ACE Kids Act

CHAT Support Letter to Senator Cornyn on ACE Kids Act

Our state’s children deserve to grow up as healthy as possible, and we should ensure that they have access to top-quality health care.

On behalf of the millions of children and families served by children’s hospitals across the U.S., we call on Congress and the White House to make children the strong bipartisan priority they must become for our nation to have a brighter future.  This full-page ad ran in the @nytimes on April 23.  Please tell your elected leaders in Washington that you support maintaining funding for Medicaid and children’s hospitals.  Read Full-Page Ad.

CHAT’s 85th Legislative Priorities

Sustain Funding for the Safety Net Add-on to Inpatient Hospital Rates

The General Appropriations Act for the 2016-17 biennium provided $64 million in Trauma Funds ($150 million AF) per year to increase inpatient reimbursement for hospitals that treat a high percentage of Medicaid and low-income uninsured, with 10% distributed based on quality metrics.

  • Children’s hospitals will receive about $24 million in safety net add-on payments and $8 million in awards for achieving quality metrics in the current biennium.
  • The same funding source was also used for the trauma add-on to most Medicaid-participating hospitals (not children’s hospitals), as well as for providing full-cost reimbursement to rural hospitals for outpatient services.
  • These Trauma Fund commitments ($221 million) have depleted reserve Trauma Funds.
  • Trauma Funds are generated from penalties related to the Driver Responsibility Program (DRP), and a number of groups (with significant legislative support) seek abolishment of the DRP.
  • There will be significant competition for dwindling Trauma Funds.

CHAT supports maintenance of funding for the safety net add-on to inpatient hospital rates.  

Increase Medicaid Outpatient Reimbursement

More than 2 million outpatient visits occurred at CHAT member hospitals in 2014. Children’s hospitals incur substantial Medicaid shortfalls because of low Medicaid payment rates for outpatient services. A recent survey of the seven CHAT members indicated a total annual loss of $58 million.

  • For children’s hospitals with high volume Medicaid, current rules limit reimbursement to 76% of allowable charges.
  • “High volume” is defined as Medicaid outpatient payments totaling at least $200,000 during calendar year 2004.
  • Outpatient services have not had a rate increase since 2007, and rate reductions impacting children’s hospitals occurred in both the 2010-11 and 2012-13 biennia.
  • Improved rates would incentivize use of outpatient care, with lower costs for appropriate services provided closer to home.

CHAT supports an increase in outpatient hospital reimbursement rates.

Improve the Medical Care Provided to Children in Foster Care

Youth in foster care have higher instances of physical, developmental, dental, and behavioral health conditions than any other group of children.  One-third of children in foster care have a chronic medical condition and up to 80% of children enter care with a significant mental health need. Protecting the health of children in the conservatorship of the state requires higher standards for care delivery, enhanced information sharing, better coordination between our health and child welfare systems, and health care providers with expertise in serving this population.

CHAT supports the following recommendations to ensure timely and appropriate medical services for children in the Texas foster care system:

Children entering foster care in Texas are required to receive a well child visit within 30 days. This standard is met for only half of the children.  The American Academy of Pediatrics (AAP) recommends that children be seen within 72 hours to screen for significant health concerns.  Plans are underway for a pilot to test the operational aspects of adopting this requirement in Texas.  The state should adopt the AAP standard and ensure the standard is met for all children.

To avoid placement disruptions and lengthy hospital stays beyond days that are medically necessary, the Department of Family and Protective Services (DFPS) should place Child Protective Services (CPS) workers in children’s hospitals and/or foster care clinics. CPS workers can retrieve information available in DFPS records, consult medical providers regarding appropriate placements, communicate treatment plans to foster care parents, and ensure that adequate in-home supports for children with complex medical needs are in place prior to discharge.

To provide quality health care to children in foster care, the state should build local capacity for specialized foster care clinics with expertise in child welfare and trauma-informed care. The Medical Child Abuse Resources and Education System (MEDCARES) program, developed to improve the assessment, diagnosis and treatment of child abuse and neglect, could be used as a model. One potential funding option for these clinics is state funding that would be matched by the federal government for Network Access Improvement Programs (NAIP) available through Medicaid.   

Medicaid is Vital to Children and the Providers that Serve Them

Without adequate funding, children’s hospitals cannot continue to provide services that children – those who need an organ transplant or heart surgery, or need treatment to cerebral palsy or spina bifida – desperately need.  Of the more than 7 million children in Texas, almost half – 3.5 million children – receive their health care through Medicaid or the Children’s Health Insurance Program (CHIP).  Because so many children in Texas are enrolled in Medicaid and CHIP, children’s hospitals are heavily dependent on these programs.


As discussion of Medicaid reform occurs at both the federal and state levels, protecting Medicaid for children helps ensure that they get access to appropriate health care.  Early detection and intervention are the best ways to help kids get off to a good start.  Children enrolled in Medicaid are more likely to attend school, graduate from high school and go to college, becoming healthier adults who will earn more and pay more in taxes than those children who do not have appropriate health care. 


Keep Kids Healthy

Investments in sound public health policies are the first line of defense against preventable injury, disease and disability and the resulting medical care costs.

  • Injury Prevention

    The leading cause of death for all teens in the United States is motor vehicle crashes. Drownings, accidental suffocations and child abuse continue to take a far too high toll on children.  Texas and its local communities can reduce the loss of life, pain and suffering by improving injury prevention activities.

  • Immunizations 

    Immunizations that protect children against the dangers of vaccine-preventable diseases are one of the great successes of the medical care and public health systems in Texas. Death and disability from diseases like smallpox, polio, mumps and whooping cough have been reduced dramatically because of immunizations. However, vaccine-preventable diseases are a continuing threat in Texas. Strong, continuing efforts to maintain high immunization rates among children and to improve adult immunization rates are essential.

  • Tobacco Control 

    There is no risk-free exposure to smoke.  Maternal exposure leads to higher rates of prematurity and childhood exposure results in higher rates of asthma and respiratory tract infections.  Four out of five smokers start by age 18.  Reducing exposure to secondhand smoke in all indoor workplaces will make a significant difference in the health of Texans and especially children.

  • Human Trafficking

    Sadly, human trafficking is among the most lucrative criminal enterprises in existence today. Trafficking can involve school-age youth, particularly those made vulnerable by challenging family situations, and it can take a variety of forms including forced labor, domestic servitude, and commercial sexual exploitation.

Cover Kids

All children should have health insurance that covers the comprehensive services that children need, from prevention to specialized care for the most complex problems, whether they are covered by public or private insurance.

Children’s Hospitals Provide High Quality Pediatric Health Care.

Children’s hospitals are the pediatric safety net for all Texas children and have unique services and expertise in the care of children.  Children’s hospitals serve our state’s most ill children – specialized care that they cannot receive elsewhere for congenital heart conditions, neurosurgery, transplants, cancer and other serious conditions.

Texas has one of the fastest-growing child populations in the country. To meet the needs of our children, it is critical to build the clinical facilities and programs needed to serve our children, from primary care to the most advanced specialty services.  Children’s hospitals are recruiting and training doctors, nurses and other pediatric providers to meet the needs of children as well as conducting research to improve and advance the efficiency and effectiveness of medical care.

State funding through Medicaid and CHIP as well as community support are essential to ensure that children’s hospitals can meet the growing needs and challenges in our state.  Any child who needs the services available through a children’s hospital should be able to get that care.

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