Insurance Coverage Unstable for Ohio Kids with Special Health Care Needs

Tuesday, June 15, 2010

A third of Ohio children with special health care needs have unstable or inadequate insurance coverage despite the fact that they may qualify for government health programs, according to a new data analysis by the Child Policy Research Center at Cincinnati Children’s Hospital Medical Center.

“Two out of three uninsured kids with special health care needs are eligible for current public programs,” said Gerry Fairbrother, Ph.D., associate director of the Child Policy Research Center at Cincinnati Children’s and a professor at the University of Cincinnati. “Quality of care for these kids is critically important. Enhanced efforts at reaching and retaining all Medicaid-eligible children would capture some of those under- or uninsured, and potentially help reduce additional high costs engendered to their families and the health care system.”

Some 445,200 children, or 16.2 percent of all Ohio children, met the screening criteria to be classified as having a special health care need, which include those with functional limitations, emotional, behavioral and development needs, specialized therapies, above routine service, or ongoing prescription medications, according to the Data Resource Center for Child and Adolescent Health (DRC). This organization conducted a national survey in 2005/06 to gather data during in-depth interviews with the parents of 750 to 850 children with special health care needs in each state and the District of Columbia. DRC also has national and state-based data on more than 100 indicators from the National Survey of Children’s Health and the National Survey of Children with Special Health Care Needs.

The survey shows that Ohio children with special health care needs are more likely to be insured than not. However, about 8 percent of these children were uninsured at some point during the study year, and 12 percent of Medicaid-eligible children with special health care needs were uninsured at some point during the study year, 2005 to 2006.

Many Ohio families – 32 percent – report that their coverage is not adequate, whether from private insurance or Medicaid. The problem is most severe for families who earn just a little too much to qualify for Medicaid, and the data show that 43 percent of families in this group have inadequate coverage.

“Unreasonable” out of pocket costs was the most frequently (31 percent) cited problem of privately insured children. Nationally, such expenditures are significantly higher for children with special health care needs, both medical expenditures borne by health care providers and insurers, well as out-of-pocket costs borne by families.

  • Average out-of-pockets costs are $535 per child, compared to $192 for other children.
  • Medical expenditures for these children average $3,171 in contrast to $1,172 for those without special needs and can be as high as $7,113 for children with functional limitations.

“While staggering, these figures speak nothing of the additional family-level socioeconomic impact involved in caring for these children. Approximately 15 percent of all insured families have financial problems associated with providing health care for a child with special health care needs, and that triples to 45 percent for those without insurance coverage,” said Anthony Goudie, Ph.D., assistant professor of pediatrics, University of Cincinnati College of Medicine, and lead author on the report. “Approximately one-third of all these families covered with public insurance or uninsured had one family member cut-back hours or leave the workplace altogether due to the child’s health conditions.”

According to survey data, publicly-insured (Medicaid) children with special health care needs in Ohio have more complex conditions than privately-insured children, and their needs extend beyond the health care system.

  • There are nearly twice as many publicly-insured children with attention-deficit hyperactivity disorder or attention deficit disorder as privately-insured (44.3 percent vs. 26.2 percent).
  • There are twice as many publicly-insured children with depression, anxiety or other emotional problems as privately-insured (31.8 percent vs. 15.0 percent).

A higher proportion of children with special health care needs insured through Medicaid exhibit functional difficulties due to health conditions that may extend beyond the health care sector (i.e., acting out, fighting bullying or arguing [52 percent Medicaid vs. 19 percent private], or difficulties learning, understanding, or paying attention [52 percent Medicaid vs. 33 percent private]).

“These children are very sick with expensive health care costs,” said Dr. Fairbrother. “Often, diagnoses are coming late, causing undue burden on the kids, their families, health care providers and insurers, when early intervention has proven to decrease the amount and cost of care needed for them.”

About The Child Policy Research Center

The Child Policy Research Center (CPRC) was established in 1999 to serve as an important community liaison between policymakers and health services researchers by providing data analysis and interpretation to community leaders and policy makers interested in the physical, emotional and social well-being of children. The Center began its expansion in 2007 and has broadened its focus to develop, translate and communicate evidence to measurably improve child health and well-being and the quality of health care for children. The CPRC partners include community, local, state and national policy makers, program managers and advocates. The Center addresses the most urgent challenges facing children and families.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center is one of 10 children’s hospitals named to the Honor Roll in U.S. News and World Report’s 2009-10 America’s Best Children’s Hospitals. It is ranked #1 for digestive disorders and highly ranked for its expertise in respiratory diseases, cancer, neonatal care, heart care, neurosurgery, diabetes, orthopedics, kidney disorders and urology. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health (NIH). Internationally recognized for quality and innovation by The Joint Commission, the Institute for Healthcare Improvement and the federal Agency for Healthcare Research and Quality, it has collaborations with hospitals and health systems around the world. Additional information can be found at 

Contact Information

Thomas McCormally