Medicaid Expenditures Among Children With Noncomplex Chronic Diseases.

Area of Science:

• Pediatric healthcare economics
• Chronic disease management
• Health services research

Background:

• Healthcare expenditures for children with noncomplex chronic diseases (NC-CDs) are linked to disease complexity and resource utilization.
• The specific conditions driving high costs among these children remain largely uncharacterized.

Purpose of the Study:

• To characterize patient demographics, healthcare expenditures, and service utilization patterns in children with NC-CDs across different spending tiers.
• To identify the key conditions and service types contributing to the highest healthcare expenditures.

Main Methods:

• Retrospective cross-sectional analysis of the 2014 Truven Medicaid MarketScan Database.
• Inclusion of continuously enrolled children (<18 years) with NC-CDs (n=1,563,233).
• Analysis of per member per year (PMPY) spending and service use (inpatient, outpatient, pharmacy) stratified by expenditure groups; K-means clustering for high-expenditure subgroup analysis.

Main Results:

• Medicaid PMPY spending varied widely, from $1466 (lowest) to $57,300 (highest).
• Children in the highest expenditure group were twice as likely to have a mental health condition diagnosis (72.7% vs 34.1%).
• Cluster analysis revealed three high-expenditure groups: high outpatient mental health ($18,814 PMPY), high inpatient ($92,950 PMPY), and high pharmacy ($325,412 PMPY). Mental health conditions comprised half of inpatient diagnoses in this group.

Conclusions:

• A small fraction (1%) of children with NC-CDs accounted for a substantial portion (20%) of total Medicaid expenditures.
• Mental health conditions represent a significant driver of aggregate Medicaid spending in children with NC-CDs.
• These findings underscore the economic impact of mental health comorbidities in pediatric chronic disease management.