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

• DOI: 10.1001/jamanetworkopen.2023.48890
• Publication Date: 2023-12-26T16:00:52Z
• Authors: Asiya Validova; Douglas Strane; Meredith Matone; Xi Wang; Rebecka Rosenquist; Xianqun Luan; David Rubin
• Keywords: Special Needs

Importance A rise in pediatric underinsurance during the last decade among households with children special health care needs (CSHCN) requires a better understanding of which households, by burden or income level, have been most impacted. Objective To examine prevalence across categories child medical complexity and variation within these different levels household income. Design, Setting, Participants This cross-sectional study used data from National Survey Children’s Health included 218 621 US 2016 to 2021. All did not reside any type institution (eg, correctional institutions, juvenile facilities, orphanages, long-term facilities). Data were analyzed January December Exposures The primary exposure is categorization constructed using parent-reported physical behavioral conditions, as well presence functional limitations. Main Outcomes Measures outcome variable underinsurance, defined absence consistent adequate insurance. Models adjusted for demographic socioeconomic characteristics stratified Multivariate logistic regression analysis pooled survey multiple years (2016 2021) complex design (weights). Results In total sample who institutions aged 0 17 2021 (105 478 [48.9%] female; 113 143 [51.1%] male; 13 571 [13.0%] non-Hispanic Black children; 149 706 [51.2%] White children), was higher had conditions (3316 [37.0%]), mental (5432 [38.1%]), limitations (1407 [40.7%]) (3442 [41.1%]), compared healthy (ie, without limitations) (52 429 [31.2%]). association between varied earning 200% 399% federal poverty level (FPL), associated having (OR, 2.74; 95% CI, 2.13-3.51) 2.21; 1.87-2.62), children. 400% more above FPL, children’s 3.31; 2.82-3.88) Conclusions relevance this study, odds being underinsured uniform CSHCN. Both daily led increased underinsured. concentration middle-income underpinned challenge financing families CSHCN whose incomes surpassed eligibility thresholds dependent Medicaid