The Moderating Effects of Waiver Enrollment and Home Nursing Care on Hospitalization Risk

Area of Science:

• Pediatric Health Services Research
• Health Economics and Outcomes Research
• Chronic Disease Management

Background:

• Medicaid-insured children with medical complexity (CMC) face high hospitalization risks.
• South Carolina's Medically Complex Children's Waiver (MCCW) and home nursing care (HNC) are potential interventions.
• Understanding factors influencing hospitalization is crucial for optimizing care.

Purpose of the Study:

• To identify factors associated with hospitalization in South Carolina's Medicaid-insured children with medical complexity.
• To examine the moderating effects of MCCW enrollment and HNC receipt on hospitalization risk.
• To analyze hospitalization trends from 2019 to 2022.

Main Methods:

• Retrospective analysis of 783,149 Medicaid claims for 4,484 children (0-21 years) in South Carolina (2019-2022).
• Utilized the Pediatric Medical Complexity Algorithm v3.0 and ICD-10 codes to classify diagnoses as complex chronic disease (C-CD) or non-complex chronic disease (NC-CD).
• The primary outcome was at least one hospitalization during the study period.

Main Results:

• Children with C-CD, aged 0-4 and 20-21, belonging to minority racial/ethnic groups, and receiving services in 2020-2021 had higher hospitalization risk.
• HNC demonstrated a mediating effect on hospitalization risk for CMC with C-CD.
• Children with C-CD receiving HNC had significantly lower hospitalization risk (AOR 0.87) compared to those with NC-CD. HNC receipt in 2020 and 2021 was associated with lower odds of hospitalization.

Conclusions:

• MCCW enrollment offers some reduction in hospitalization risk.
• HNC appears to be a significant factor in reducing hospitalization risk, particularly during the COVID-19 pandemic.
• Further research is needed to refine understanding and improve health outcomes for these children.