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Variability In States' Coverage Of Children With Medical Complexity Through Home And Community-Based Services Waivers
Jessica Keim-Malpass1, Leeza Constantoulakis2, Lisa C Letzkus3
1Jessica Keim-Malpass ( jlk2t@virginia.edu ) is an assistant professor in the School of Nursing, University of Virginia, in Charlottesville.
Insights
Medicaid waivers for children with medical complexity vary significantly by state. This variability in coverage and services may affect child and family health outcomes, despite increasing expenditures.
Area of Science:
- Health Services Research
- Pediatric Healthcare Policy
- Health Economics
Background:
- Children with medical complexity (CMC) are a small but costly segment of the pediatric population.
- Home and community-based care for CMC is often funded through Medicaid waivers (Section 1915(c)).
- Annual spending on these waivers exceeds $48 billion, with a trend of increasing expenditures.
Purpose of the Study:
- To analyze the scope of coverage provided by Medicaid waivers for CMC.
- To evaluate how states utilize these waivers for CMC care.
- To address the lack of defined data on waiver components and effectiveness.
Main Methods:
- Analysis of waiver scope of coverage.
- Evaluation of state-specific service provision for CMC.
- Assessment of variability in waiver interpretation and service offerings.
Main Results:
- Significant variability exists in how states define waiver coverage scope.
- States demonstrate diverse approaches to offering services for CMC.
- Interpreted scope of coverage and services varies considerably across states.
Conclusions:
- State-level variability in Medicaid waiver interpretation impacts CMC care.
- The diverse application of waivers may influence child and family outcomes.
- Further research is needed to understand the economic impact and effectiveness of these waivers.
Abstract:
Even though children with medical complexity represent less than 1 percent of the US pediatric population, they are among the costliest users of the health care system. Much of the care for these children is delivered in home and community-based settings and covered by Medicaid waivers under Section 1915(c). Expenditures related to these waivers have been steadily increasing, with most recent estimates showing spending that exceeds $48 billion per year. Little is known about these waivers' economic impact or effectiveness, because their components and coverage have not previously been well defined. Our study addressed this paucity of data by analyzing the scope of coverage offered by the waivers and evaluating how states are using them to cover children with medical complexity. We found great variability in how states choose to interpret scope of coverage and services offered, and this variability may have an impact on child and family outcomes.