EVALUATING COMMUNITY EFFORTS TO DECATEGORIZE AND INTEGRATE FINANCING OF CHILDRENS HEALTH-SERVICES

Publicly funded categorical programs for children often differ in elig ibility rules, allowable services, and criteria for provider participa tion, making it necessary for families to navigate through several pro grams to piece together care for their children. Recognizing these pro blems, the Robert Wood Johnson Foundation launched a national demonstr ation project in 1991 with the goal of decategorizing children's healt h services in nine communities. Ir was hoped that: by releasing funds from categorical restrictions on their use, scarce public resources co uld be directed where they might have the greatest impact. However, th e demonstration sites confronted a number of challenges in designing a nd implementing decategorization strategies: an absence of existing mo dels and effective technical assistance; political hurdles in gaining cooperation from the multiple local agencies engaged in service provis ion; and difficulties in carrying out major programmatic changes when the health care system itself was rapidly being transformed. The propo sition that decategorization holds promise as a tool for improving acc ess to health care deserves further investigation.