Medicaid Managed Care - U.S. Senate Special Committee on Aging

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THF VARIAI LITY
OF SPENDING
Medical conditions affecting children with special needs-and the result.
ing cost. of their care-vry enomously.
ioe euapie a sn-to-be pUished artide In PFofare (ireys. Anderson
Shaffer et Neff) soAs that In 1993 Wasington ate's <strong>Medicaid</strong> prngrm
spent on ormoge-
514.377 for a child with cystic fibrosis
S16.684 for child with muscular dystrophy
514.637 for a child with a malignant neoplasm
$52,84 for a child with asthma
The total spending for d children In the state provide a different picture -
S37 meliton for all children with asthma -
58.4 millon for all children with malignant neoplasss
52.9 millIon for all children with cystic fibrosis
$2.6 million for all children with cerebral palsy
Thus the condition least espensive to teat-asthma-costs the program
far more than more espensine. but far rarer, conditions.
Health plan limits on services covered may put the must
direct .nancial stress on hfmilies. Plans iscerasiegly ressect
the number of services or types of benefits they cover For
ecsample a plan may limit the number of meneal health or
physical thepy sessions or may cover hore care for only
short periods Plans may also be slow to cover the ose of
new technologics and therapeutic interventions
WHO PAYS?
Financing the care of special needs children is considerubly
fragmented, and national data are onavailable to how the
number in prnnate plans, <strong>Medicaid</strong> and ocher public health
pogranms - much less in managed care a-rangemess
funded by either the public or prNvate sector
We do koow that 1 4 million children with special
health needs ane oninsured Io addition, we koow fron a
survey of inpatient discharges frorn 49 child-ns hospitals
(see Figom |) that -
* 36% of children withspecial health needs were
assisted by <strong>Medicaid</strong>; and
* 4096 had prNvate insura-ce.'
Children with special needs are more likely than healthy
children o be lining in households with I.oer incomes and
with adults who have less edscatie.n They ae half again
more likely to live at or below poverty, and thus depend on
<strong>Medicaid</strong> Chtrnic childhood conditions increase with age
and affect males moen than females White aed Afican
American children are mere often reported to have special
-health needs than Latino or other raci and ethnic groups
A Census Buras survey from 1993 94 shows that 32%
with disabilities under age 21 wem on <strong>Medicaid</strong>.' Children
can rNceive <strong>Medicaid</strong> benefits if their disbilities and fmily
income qulify them for Suppiemenl Secunry Incume
(SSI), if buily incomes are low enough, or if they meet
other reqinrmeots that vty fromn state to state As many as
30,000 children may lose <strong>Medicaid</strong> coverage, because of
changes the 1996 welfne refoe law made to SSIs dehnilion
of disability
THE COST
OF CARE
There are no cuerent reliable national estimates on the
cost of canng for children with special needs. But
<strong>Medicaid</strong> data provide some glimpse of what it costs to
nece children with disabilities Disabled children on
<strong>Medicaid</strong>, with incomes low enough to qualify for
Supplemental Secunrity Incsme (SS), are more likely to
have severe higher cost conditions than others with special
needs, in 1995, state and federal goveromenis contnbuted
through <strong>Medicaid</strong> $6.8 billion, or 7,128 on
acerge for each of 9553000 disabled children The aver-
in many cases, pevately insured children can recerte
additional assistance frnm publicly funded pnogms, even
<strong>Medicaid</strong>, to cover what the pnvate plan does not (See has
'EPSDT - The Debate ') In addition, al special needs children
have acces to some reson-es so help manage some of
their health and education eeds, including ssistane from
the federally funded but stte-operted matemal and child
health block grants This aid vaies fron sate to stare but
can include direct provision of medical care
Them am also a number of stare and fedemi pgrmam that
provide eady intrveendon to help childres ovecome develop-
Figure 1
age for all children on <strong>Medicaid</strong> in 1996 was about $920.
(See boo 'The Variability of Spending.')
The most consistently vopensive children are those who
require instimotional care or have long-standing dependency
on such enpensive technologies as respiraors For noninstitosiooelized
children, much of the cost is deven by
hospital stays. These children are nearly 4 times more likely
to be hospialiced, have longer stays and nee physician
three times mone often than healthy kids Those with physical
health conditions are more than twice as likely to hane
secondary mental health problems.
The out-of-pocket expeon-s of families who care for
THF PAYFRS
roed Vsaaeinl -
a Child Health
2%
Othe
3%
children with special needs ae not well docomented Nor
ar there good data on how family responsibilities in caneg .oo em{ ads cr us
for these children effect poreots' employment, or their
physica and mental health. But hfmilie rpon that al
these may be areas of stress, prodocing additional personal
and financial costs
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