Comparing the Economic and Social Prevalence Among Special Needs Children who received health insurance through Medicaid/CHIP

The Kaiser Family Foundation has released an issue brief (below) with an in-depth analysis comparing the economic and social prevalence among special needs children who received health insurance through Medicaid/CHIP, private insurance, a combination of Medicaid/CHIP and private insurance, or who are uninsured. The analysis from Kaiser shows that children with special needs who benefit from Medicaid/CHIP have increased health access and their families experience lower financial burden in comparison to their counterparts. In addition, financial caps to state Medicaid/CHIP programs could present risks to this population.


Key Findings

Medicaid and CHIP covered about half (47%) of the 13.3 million children with special health care needs in 2017. These children require medical and long-term care services due to intellectual/developmental disabilities, physical disabilities, and/or mental health disabilities. Medicaid/CHIP is the sole source of coverage for 39% of these children, and another 8% have Medicaid/CHIP to supplement their private coverage. Medicaid plays a key role for children with special health care needs by making coverage affordable and covering services that private insurance typically does not. This issue brief compares key characteristics of Medicaid/CHIP-only children with special health care needs to those with both public and private insurance, private insurance only, and those who are uninsured. For example:

• Medicaid/CHIP children with special health care needs are significantly more likely to live in low income families compared to those with private insurance only. Over eight in 10 (83%) Medicaid/CHIP-only children with special health care needs live in families with incomes below 200% of the federal poverty level (less than $42,660/year for a family of three in 2019), compared to less than two in 10 (17%) of those with private insurance only.

• Medicaid/CHIP children with special health care needs are significantly more likely to have multiple health conditions and to be in poorer health compared to those with private insurance alone, with children with both Medicaid/CHIP and private insurance having the greatest needs. For example, children with special health care needs with both Medicaid/CHIP and private insurance (50%) are twice as likely to have four or more functional difficulties compared to those with private insurance alone (25%). Medicaid/CHIP fills in gaps in private insurance and makes coverage affordable for these children.

• Medicaid/CHIP children with special health care needs are more likely to report that their coverage is affordable compared to those with private insurance alone. For example, those with Medicaid/CHIP only are four times as likely (78%) to report that their out-of-pocket health care costs are always reasonable compared to those with private insurance alone (19%). Over half (53%) families of Medicaid/CHIP-only children with special health care needs find it somewhat or very often hard to cover basic needs like housing or food since their child’s birth, compared to a fifth (19%) of those with private insurance only.