The Role of Medicaid and SCHIP Coverage in Serving Children with “Special Health Care Needs”

1. The Role of Medicaid and SCHIP Coverage in Serving Children with “Special Health Care Needs” Lisa Dubay, Ph.D. Sonia Ruiz, Ph.D. Johns Hopkins Bloomberg School of Public Health

2. The Old Notion of Child Health • Vast majority of children are in excellent, very good, or good health • Fewer than 1 in 10 children have a long-term medical disorder • Lack of significant chronic disease has led to popular notion that children are generally “healthy” • This myopic vision fails to recognize the unique needs of children

3. A 21st Century Version of Child Health • “Children’s Health: The Nation’s Wealth” defined child health as: • “the extent to which individual children or groups of children are able or enabled to 1) develop and realize their potential; b) satisfy their needs; and c) develop the capacities to allow them to interact successfully with their biological, physical and social environments.”

4. New Research • Examine a variety of measures of health status along the following dimensions: • Whether the measure demonstrates an income gradient • The prevalence of each health status measure by insurance coverage • The distribution of “poor health” by insurance coverage

5. Methodology • Use 2005 Medical Expenditure Panel Survey (MEPS) • Consider the following measures of health status: • Perceived health status • Perceived mental health status • Limitations in ability to do things most children the same age can do • Columbia Impairment Scale • Children with special health care screener

6. Columbia Impairment Scale • Rate from 0 (no problem) to 4 (a very big problem). Dichotomize responses to represent having a 3 or 4 on any of the following categories: • getting along with mother • getting along with father • feeling unhappy or sad • (his/her) behavior at school • having fun • getting along with adults • feeling nervous or afraid • getting along with brothers and sisters • getting along with other kids • getting involved in activities like sports or hobbies • (his/her) schoolwork • (his/her) behavior at home • staying out of trouble

7. Children With Special Health Care Needs Screener • Child needs or uses prescribed medicines • Child needs or uses more medical care, menthol health, or education services that is usual for most children of the same age • Child is limited or prevented in anyway in ability to do the things most children of the same age can do. • Child needs or gets special therapy such as physical, occupational, or speech therapy • Child has an emotional, developmental, or behavioral problem for which he/she needs or gets treatment of counseling • The health consequence is attributable to a medical, behavioral or other health condition AND has lasted or is expected to last at least 12 months

8. Perceived General Health Status

9. Perceived Mental Health Status

10. Child is Limited in Daily Activities

11. Columbia Impairment Scale

12. Child Has “Special Health Care Needs”

13. Perceived General Health Status Prevalence Distribution

14. Perceived Mental Health Status Prevalence Distribution

15. Limited in Daily Activities Prevalence Distribution

16. Columbia Impairment Scale Prevalence Distribution

17. Children with “Special Health Care Needs” Prevalence Distribution

18. Conclusions • Medicaid serves a distinctly less healthy population of children relative to other types of insurance coverage • A large share of children – almost 20 percent -- have a behavioral or emotional issue their parents perceive as a big problem.

19. Policy Implications • Regulations proposed by the Bush administration are likely to reduce access to critical service for children who are poor and are in need of complex developmental services • While children with public coverage are “protected” from uninsurance with EPSDT, low-income privately covered children are likely at great risk for not having their health care needs attended to.