Is Medicaid, the largest insurer of children with special health care needs, in danger?

Abstract

In this issue of Pediatrics , Weller et al,1 using the 1994 National Health Interview Disability Survey, describe how insurance and sociodemographic characteristics influence the use of medical and other health-related services by school-aged children and adolescents with special health care needs. The 4 medical services included physician, hospital, emergency department, and mental health. The 7 health-related services included therapeutic, social work, medical care coordination, nonmedical care coordination, assistive devices, transportation, and housing modifications. Using logistic regression techniques, the investigators found that age, race/ethnicity, and parental education were significantly associated with multiple medical and health-related services. Racial/ethnic disparities were identified even after adjusting for poverty, health status, and insurance in the use of health related services. The findings also suggest that children of color are less likely to use community-based physicians and more likely to use hospital and emergency department services. The findings also provide evidence that Medicaid programs are successful in ensuring that children with special health care needs do receive needed services, as children with either public insurance alone or in combination with private insurance were more likely than privately insured children to … Address correspondence to Steve Berman, MD, Children’s Hospital, 1056 E 19th Ave, B032, Denver, CO 80218. E-mail: berman.stephen{at}tchden.org