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Study Analyzes Medicaid Programs for Children with Medical Complexities
According to a study from the Ann & Robert H. Lurie Children's Hospital of Chicago published in the journal JAMA, Medicaid eligibility and coverage for children with medical complexities varies greatly by state, raising health equity concerns, especially as families move across state lines. The study focused on Medicaid programs for these children that went beyond the family's traditional income-based eligibility. “State-by-state differences in Medicaid eligibility and coverage affect access to services for children with medical complexities, resulting in delays in care and impacting...
Study Analyzes Medicaid Programs for Children with Medical Complexities
According to a study from the Ann & Robert H. Lurie Children's Hospital of Chicago published in the journal JAMA, Medicaid eligibility and coverage for children with medical complexities varies greatly by state, raising health equity concerns, especially as families move across state lines. The study focused on Medicaid programs for these children that went beyond the family's traditional income-based eligibility.
“State-by-state differences in Medicaid eligibility and coverage influence access to services for children with medical complexities, which can lead to delays in care and impact health outcomes for these children,” said lead author Jennifer Kusma, MD, MS, a pediatrician at Lurie Children’s and Instructor of Pediatrics at the Northwestern University Feinberg School of Medicine.
Children with medical complexity have at least one complex chronic condition resulting in functional limitations, family health needs, and dependence on medical technology. Because of the high out-of-pocket health care costs for the therapies these children require, pathways have been created for children with medical complexity to qualify for Medicaid based on medically relevant criteria in addition to their parents' employer-based insurance. These include medically indigent care, waivers to cover the cost of institutional-level care in the home setting, and waivers that focus on home and community-based services. States vary in whether they offer one or more of these options. States also vary in whether children with medical complexity are covered by Medicaid managed care or fee-for-service Medicaid programs, or a combination of these health plans.
The study used semi-structured interviews with 43 state Medicaid representatives from 23 states and Washington, DC, to clarify differences in eligibility and coverage that state Medicaid programs provide for children with medical complexity.
Dr. Kusma and colleagues found that variation in state Medicaid programs for children with medical complexity can be profound. For example, while these children may gain access to Medicaid coverage within months in one state, they may wait years for coverage in another state.
Our findings can inform future advocacy efforts regarding policy changes to address the needs of these vulnerable children, while recognizing that state disparities may persist over time.
Jennifer Kusma, MD, MS, lead study author and pediatrician, Ann & Robert H. Lurie Children’s Hospital of Chicago
Matthew Davis, MD, MAPP, and Carolyn Foster, MD, MSHS, both of Lurie Children’s, are co-authors of the study.
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted by the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine, and ensuring a healthier future through the relentless pursuit of knowledge. Lurie Children’s is ranked one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training center of the Northwestern University Feinberg School of Medicine.
Source:
Ann & Robert H. Lurie Children's Hospital of Chicago
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