Chapter 1 includes four recommendations aimed at addressing challenges with transitioning from pediatric to adult care in Medicaid. Medicaid plays an important role in covering health care services for children and youth with special health care needs (CYSHCN). Almost one in five children has special health care needs, and Medicaid covers almost half of these children. As these children reach adulthood, they need to transition from a pediatric to an adult model of care.
Findings from MACPAC’s work demonstrate that Medicaid-covered CYSHCN can experience challenges during this time, which include transitioning to new adult providers, potential loss of covered benefits, medical complications, and poor health outcomes. State transition of care strategies lack both clear documentation and communications as well as individualized transition of care plans. There is also little guidance to states on coverage of services to support transitions of care and a lack of data collection on this population. Finally, there is limited state Medicaid and Title V agency coordination on CYSHCN transitions of care.
The recommendations would require states to develop a strategy for transitions of care for CYSHCN, which includes developing an individualized transition of care plan and making the strategy publicly available, issuing guidance to states on existing authorities to cover transition of care-related services for CYSHCN, requiring states to collect and report data on access to transition of care-related services as well as beneficiary and caregiver experiences with transitions, and requiring interagency agreements between state Medicaid and Title V agencies to specify the roles and responsibilities of the agencies in supporting CYSHCN transitions from pediatric to adult care.
From: June 2025 Report to Congress on Medicaid and CHIP