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Hundreds of Thousands of Medically Vulnerable Children Uninsured
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In 2003, an estimated 13.5 million children, or 18.5 percent of all American children, had a special health care needdefined as an ongoing physical, emotional, behavioral, developmental or other health condition causing them to use more health services or limit their activities more than children generally.
Medicaid or the State Childrens Health Insurance Program (SCHIP) covered nearly two out of five children with special health care needs, or about 5.2 million children, the study found. Nonetheless, an estimated 650,000 children with special health care needs were uninsured in 2003, and many were likely eligible for public coverage but not enrolled.
"Public health insurance clearly provides a critical safety net to millions of children with special health care needs, but hundreds of thousands of these medically vulnerable children remain uninsured," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
The study findings counter the conventional wisdom that all uninsured children generally are healthy and that uninsured children eligible for public insurance would gain coverage if they became ill.
"The findings should help dispel the myth that all uninsured children are healthy and points out that a significant number of children with special health care needs are probably eligible for public coverage but not enrolled" said Ha T. Tu, M.P.A., an HSC health researcher and coauthor of the study with HSC Senior Health Researcher Peter J. Cunningham, Ph.D.
Among special-needs children, those with public and private coverage reported about equal rates of problems obtaining health care, indicating Medicaid and SCHIP provide comparable access to care. Overall, children with special needs faced more access problems than other children, and their families reported more problems paying medical bills.
Based on HSCs Community Tracking Study Household Survey, a nationally representative survey of 46,600 persons, the study included information on 7,327 children 18 years of age and younger, of whom 1,523 were identified as children with special health care needs. The survey used the Children with Special Health Care Needs (CSHCN) Screener, a standardized five-question survey module developed collaboratively by state and federal policy makers, health care providers, researchers and consumer organizations.
The studys findings are detailed in a new HSC Issue BriefPublic Coverage Provides Vital Safety Net for Children with Special Health Care Needs. Other key findings include:
Budget pressures have caused both the federal government and the states to explore ways to slow spending growth in public insurance programs. Although recent federal proposals to reduce Medicaid spending growth have focused mostly on eligibility and services for adults, during the past year some states have made it more difficult for eligible children to obtain and keep public coverage. These measures include increasing required premiums or targeting premiums to lower-income families in SCHIP, imposing enrollment freezes in SCHIP, and reinstating administrative barriers in both Medicaid and SCHIP.
""Policy measures now under consideration, such as increased cost
sharing in Medicaid and SCHIP, would likely increase access problems for children
with special health needs," Tu said. "Already, one-third of all publicly
insured special-needs children are in families with problems paying medical
bills, and thats almost certain to increase if these families have to shoulder
more health expenses."
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.