Center for Studying Health System Change

Hundreds of Thousands of Medically Vulnerable Children Uninsured

News Release
Sept. 8, 2005

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—While public health insurance provides a vital safety net to millions of children with special health care needs, ranging from learning disorders to severe disabilities, more than 650,000 of these medically vulnerable children are uninsured, according to a new national study by the Center for Studying Health System Change (HSC).

In 2003, an estimated 13.5 million children, or 18.5 percent of all American children, had a special health care need—defined 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 Children’s 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 HSC’s 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 study’s findings are detailed in a new HSC Issue Brief—Public Coverage Provides Vital Safety Net for Children with Special Health Care Needs. Other key findings include:

• Children with special health needs are less likely than other children to have private insurance (55.6% vs. 63.6%). However, because they are enrolled in public insurance programs at much higher rates than other children, their uninsurance rate is lower—4.8 percent, compared with 8.3 percent for children without special needs.
• The special-needs children most likely to lack health insurance are in families with incomes ranging from 100 percent to 300 percent of the federal poverty level—or $18,400 to $55,200 for a family of four in 2003. Special-needs children with family incomes between 100 percent and 200 percent of poverty have an uninsurance rate of 8.2 percent, while those with family incomes from 200 percent to 300 percent of poverty have an uninsurance rate of 9.8 percent.
• In contrast, most of the special-needs children with family incomes below poverty have public coverage, leaving only 2.4 percent uninsured, while most of the those with family incomes exceeding 300 percent of poverty have private insurance, resulting in an uninsurance rate of just 1.6 percent.
• · Special-needs children are almost twice as likely as other children to have had an unmet need for medical care in the past year (4.2% vs. 2.3%). And they are more than three times as likely to have had an unmet need for prescription drugs because of cost concerns in the past year (6.9% vs. 2.1%).
• Families of special-needs children covered by Medicaid or SCHIP are almost twice as likely to have medical bill problems as families of privately insured special-needs children (32.2% vs. 17.3%)—a gap that largely reflects differences in family income but also reflects poorer health status among publicly insured special-needs children.

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 that’s 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 nation’s 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.