EPSDT and Children's Coverage Costs, The Commonwealth Fund, September 2005
Despite the breadth of coverage provided to children in Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, spending per child is low compared with working-age and older adults and with the disabled ($1,736, $10,619, and $10,642 in FY 2001). On average, $1,315 was spent in FY 2001 for each child in EPSDT.
Table 1. Per Capita Medicaid Spending on Children and Children's Medicaid Enrollment by State
|Per capita Medicaid spending on childrena||Percentage of children in state enrolled in Medicaidb||Number of children enrolled in Medicaidc|
|District of Columbia||1,973||71||76,300|
|a Source: Henry J. Kaiser Family Foundation http://www.statehealthfacts.org (accessed September 6, 2005). Data are for FY 2001.|
b Source: U.S. Medicaid Facts from the AAP and NACH July 2005. Data are for FY 2002.
c Source: The Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on data from Medicaid Statistical Information System (MSIS) reports from the Centers for Medicare and Medicaid Services (CMS) 2005. Data are for FY 2001.
Only 16.2 percent of children have special health care needs, but they account for 41 percent of total spending (Figure 1).1 Publicly insured children are more likely to have special needs than privately insured children (19.2% vs. 16.2%).
Private and Public Spending on Children
In 2000, average medical expenses per publicly insured child were $1,262, compared with $1,112 per privately insured child.2 These averages are six and three times higher, respectively, than the median medical expenses for children with public ($198) and private ($366) insurance. These large differences are due to a very small group of children accounting for a disproportionate share of overall health care costs. Figure 2 shows that from 1996 to 1999, spending on Medicaid children was actually lower than spending on privately insured children when controlling for health status and other socioeconomic differences.
1 F. Chevarley, "Utilization and Expenditures for Children with Special Health Care Needs" (Washington, D.C.: AHRQ Working Paper No.05010, Feb. 2005). Available at http://www.meps.ahrq.gov/papers/workingpapers/WP_Feb2005_FMC.pdf.