The Moderating Effects of Waiver Enrollment and Home Nursing Care on Hospitalization Risk
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Caitlin Koob1, Elizabeth Mack2, Sarah Griffin3
1Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.
Insights
Home nursing care (HNC) significantly reduced hospitalization risk for children with complex chronic diseases (C-CD) in South Carolina. Medically Complex Children
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.
Objectives:
This study identifies factors associated with hospitalization and examines the moderating effects of South Carolina Medicaid's Medically Complex Children's Waiver (MCCW) enrollment and receipt of home nursing care (HNC) on hospitalization risk among Medicaid-insured children with medical complexity in South Carolina from 2019 to 2022.
Methods:
We analyzed retrospective Medicaid claims data from 783 149 billed home health care claims among 4484 children aged 0 to 21 years in South Carolina from 2019 to 2022. The outcome of interest was experiencing at least 1 hospitalization from 2019 to 2022. The Pediatric Medical Complexity Algorithm version 3.0 was applied, using International Classification of Diseases, Tenth Revision (ICD-10) codes to classify diagnoses as either a complex chronic disease (C-CD) or a noncomplex chronic disease (NC-CD).
Results:
Children with a C-CD aged 0 to 4 and 20 to 21 years who identified with a race and ethnicity other than non-Hispanic white, were primarily insured by Medicaid, and received services in 2020 and 2021 had significantly higher hospitalization risk compared with other children. Controlling for MCCW, HNC had a mediating effect on hospitalization risk for CMC with a C-CD (odds ratio [OR] 1.03, 95% CI: 1.02-1.04, compared with children with an NC-CD). Children with a C-CD who received HNC had significantly lower hospitalization risk (adjusted OR [AOR] 0.87, 95% CI: 0.85-0.89) compared with children with an NC-CD. Children who received HNC in 2020 (AOR 0.90, 95% CI: 0.84-0.96) and 2021 (OR 0.92, 95% CI: 0.86-0.98) had significantly lower odds of hospitalization(s) compared with those without nursing in 2019.
Conclusions:
MCCW enrollment lowers hospitalization risk to an extent; however, HNC may have reduced hospitalization risk throughout the COVID-19 pandemic. Further research is needed to understand the intricacies of South Carolina Medicaid's MCCW and to improve health among Medicaid-insured children in South Carolina.
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