Two new complementary reports from United Hospital Fund's Medicaid Institute present data on Medicaid spending for and utilization by Medicaid beneficiaries under the age of 21 in New York, focusing specifically on the 1.77 million who were continuously enrolled in the program for all of 2014. (Medicaid covers 2.19 million of the 5.04 million children under age 21 in New York.) The reports are part of a growing UHF body of work that examines opportunities to improve children's health, especially in the context of payment reform, including value-based payment.
The two reports (both available online) are Understanding Medicaid Utilization for Children in New York State: A Data Brief, a narrative that provides context and analysis, and Understanding Medicaid Utilization for Children in New York State: A Chartbook, which presents more extensive pie charts, bar graphs, and other figures in support of the analysis in the data brief.
Among the findings from the examination of 2014 data:
Children account for nearly 40 percent of New York State Medicaid enrollees, but less than 20 percent of the program's expenditures.
Nearly 90 percent of children averaged $2,400 in annual expenditures (compared to $11,154 for adults between the ages of 21 and 64 who were continuously enrolled in Medicaid).
A relatively small group of 185,625 continuously enrolled children, approximately 10 percent of all continuously enrolled children, account for half of Medicaid expenditures on continuously enrolled children.
Nearly 85 percent of continuously enrolled children had at least one outpatient evaluation/management or preventive care visit.
Black and Hispanic children have much higher rates of inpatient hospitalizations and emergency department utilization than white or Asian and Pacific Islander children.
Inpatient hospitalizations and emergency department utilization also vary by age, diagnosis, and geography.
Children under age 4 have inpatient and emergency department utilization driven by respiratory system diseases, including asthma; teenagers and older adolescents have a much higher portion of inpatient utilization driven by behavioral health conditions.
“As New York continues to reshape our state's Medicaid program, it would be easy to overlook children because, overall, they are a relatively inexpensive population in terms of health care spending,” said Chad Shearer, director of UHF's Medicaid Institute and an author of the new reports. “We know that adverse early childhood experiences can affect brain development and lead to increased risk for chronic disease later in life, so children's health care has some of the greatest opportunity for long-term impact on health. We developed these reports to help frame discussions about how to take advantage of such opportunities.”
“Medicaid covers 43% of New York's children, and as a dominant payer for pediatric care across the state, it has a special role to play in promoting child health,” said Andrea G. Cohen, senior vice president for program. “New York Medicaid performs better than average on core quality measures, but there is room for improvement on many measures. Racial and geographic disparities in hospitalization rates for different conditions also suggest areas for more work to improve overall child health.”
“An important subset of child Medicaid beneficiaries have significant health care needs, but we want to ensure that no children are overlooked in discussions,” said Jim Tallon, president of United Hospital Fund. “Children in New York's Medicaid program and their families often have unique needs, and reforms will need to take those into account as well.”
Both reports are available form UHF's website. Understanding Medicaid Utilization for Children in New York State: A Data Brief and Understanding Medicaid Utilization for Children in New York State: A Chartbook are available here.
About United Hospital Fund: United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care.