State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Many studies have documented the extent to which CSHCN lack insurance. Less attention has been devoted to examining underinsurance for this population and no studies have examined state variability in underinsurance. WHAT THIS STUDY ADDS:We demonstrate that underinsurance affects far more CSHCN than does lack of insurance. Our results indicate that where a child lives is strongly related to the likelihood that his or her health insurance is adequate. abstract OBJECTIVE: National attention has focused on providing health insurance coverage for children. Less awareness has been given to underinsurance, particularly for children with special health care needs (CSHCN). Defined as having inadequate benefits, underinsurance may be a particular problem for CSHCN because of their greater needs for medical care. METHODS:We used the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative study of Ͼ40 000 CSHCN, to address state variations in underinsurance. CSHCN with health insurance were considered underinsured when a parent reported that the child's insurance did not usually or always cover needed services and providers or reasonably cover costs. We calculated the unadjusted prevalence of underinsurance for each state. Using logistic regression, we estimated state-specific odds and prevalence for underinsurance after adjusting for poverty level, race/ethnicity, gender, family structure, language use, insurance type, and severity of child's health condition. We also conducted multilevel analyses incorporating state-level contextual data on Medicaid and the State Children's Health Insurance Program. RESULTS: Bivariate and multivariate analyses indicated that CSHCNЈs state of residence had a strong association with insurance adequacy. State-level unadjusted underinsurance rates ranged from 24% (Hawaii) to 38% (Illinois). After multivariate adjustments, the range was largely unchanged: 23% (Hawaii) to 38% (New Jersey). Multilevel analyses indicated that Medicaid income eligibility levels were inversely associated with the odds of being underinsured. CONCLUSIONS: The individual-level and macro-level factors examined only partly explain state variations in underinsurance. Furthermore, the macro-level factors explained only a small portion of the variance; however, other macro-level factors may be relevant for the observed patterns.

Parent-Provider-Community Partnerships: Optimizing Outcomes for Children With Disabilities

“…42 Although most families of children with special health care needs have medical insurance, underinsurance resulting in financial stress preferentially affects families of children with disabilities. 43 Reports of financial hardship are more frequent in families with children with more severe disabilities, those with lower incomes, 44 and those with certain conditions such as autism spectrum disorders. 45,46 Hopeful investment in unproven interventions can further deplete family finances.…”

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities

“…Based on our findings, we offer the following recommendations: PCPP should develop methods to (a) ''translate'' medical information on the CNDD's condition for developing a comprehensive care plan [61], (b) assess the family needs using family needs-assessment screening tools [62], (c) offer guidance on meaningful activities for recreation and healthy life styles for CNDD and their families [63], (d) gain information on and access to complementary and alternative medicine [64,65], (e) provide information on CNDD's condition that supports the development of meaningful individual education plans [66,67], (f) help gain information on and access to evidence-based behavioral interventions [68], (g) assist with outreach and follow-up on community mental health supports to address family stress, depression, domestic violence, or substance abuse [69] or siblings' support [70], (h) assist with financial resources [71] or health insurance for ''behavioral health treatments'' within the Affordable Care Act [72], (i) document medical and non-medical sources of care that are being used for CNDD in the (electronic) health-record [73], and (j) strive for cultural and linguistic competence in communicating and facilitating information pertaining to CNDD's and family's needs [74][75][76].…”

Using Population-Based Survey Data to Monitor the Health of Children and Youth with Special Health Care Needs and Disabilities

“…An article recently published in the New England Journal of Medicine described a study similar to the one summarized above, but using data from the 2007 NSCH to examine the adequacy of health insurance coverage among all children (Kogan et al 2010). Several survey items were used to construct a multivariate outcome measure categorizing children's health insurance coverage over the 12 months prior to and including the survey as: Never Insured, Sometimes Insured, Underinsured (continuously insured but inadequately covered), or Fully Insured (continuously insured and covered adequately).…”

“…Among the results of this study was the finding that 25% of CSHCN nationwide were Underinsured, compared with 18% of non-CSHCN. Compared with children without special health care needs, CSHCN were 1.3 times as likely to have inadequate coverage of needed services, 1.5 times as likely to have inadequate access to needed providers, and 1.5 times as likely to have out-ofpocket medical costs characterized by parents as unreasonable (Kogan et al 2010). …”