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Financial burden of raising CSHCN: association with state policy choices.
Pediatrics. 2009 Dec; 124 Suppl 4:S435-42.Ped

Abstract

OBJECTIVE

We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN).

SAMPLE AND METHODS

Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics.

RESULTS

Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden.

CONCLUSIONS

Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits.

Authors+Show Affiliations

School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA. parish@unc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19948610

Citation

Parish, Susan L., et al. "Financial Burden of Raising CSHCN: Association With State Policy Choices." Pediatrics, vol. 124 Suppl 4, 2009, pp. S435-42.
Parish SL, Shattuck PT, Rose RA. Financial burden of raising CSHCN: association with state policy choices. Pediatrics. 2009;124 Suppl 4:S435-42.
Parish, S. L., Shattuck, P. T., & Rose, R. A. (2009). Financial burden of raising CSHCN: association with state policy choices. Pediatrics, 124 Suppl 4, S435-42. https://doi.org/10.1542/peds.2009-1255P
Parish SL, Shattuck PT, Rose RA. Financial Burden of Raising CSHCN: Association With State Policy Choices. Pediatrics. 2009;124 Suppl 4:S435-42. PubMed PMID: 19948610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Financial burden of raising CSHCN: association with state policy choices. AU - Parish,Susan L, AU - Shattuck,Paul T, AU - Rose,Roderick A, PY - 2009/12/2/entrez PY - 2010/1/9/pubmed PY - 2010/1/23/medline SP - S435 EP - 42 JF - Pediatrics JO - Pediatrics VL - 124 Suppl 4 N2 - OBJECTIVE: We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN). SAMPLE AND METHODS: Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics. RESULTS: Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden. CONCLUSIONS: Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/19948610/Financial_burden_of_raising_CSHCN:_association_with_state_policy_choices_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=19948610 DB - PRIME DP - Unbound Medicine ER -