The problem children's hospitals set out to resolve is very real, Gremminger added, because of how difficult it is for everyone involved to treat and care for children with multiple and chronic conditions. But he said the legislation is a complicated way to tackle tricky issues that could be dealt with head-on. These include the hitches in interstate provider networks for Medicaid and the often troubled relationships between different Medicaid programs when children have to cross state lines for treatment.
"You don't need a bill that's this big and targeted," Gremminger said. "You could do an interstate provider reimbursement bill that isn't specific to kids, and have the focus on this one issue, as opposed to reinventing the wheel."
Matt Salo, executive director of the National Association of Medicaid Directors, declined to weigh in for or against the bill, given the fluid nature of the negotiations. The group opposed the early versions but he said as long as the program offers extra federal funding to make it possible, is optional and "flexible enough to appeal to multiple states," Medicaid directors can work with it.
Like Gremminger, however, he added that he isn't quite sure of the bill's core purpose.
"What problem is it truly trying to solve, the scope of what is being changed to accomplish that purpose—is this for a relatively small number of kids with special needs that truly need interstate placement to get care at specialized centers of excellence?" Salo said. "Or is it 2 million or more kids, and how on earth do you define the parameters?"