EPSDT and Children's Coverage Costs

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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 childrenaPercentage of children in state enrolled in MedicaidbNumber of children enrolled in Medicaidc
United States$1,31535%23,380,500
Alabama1,38936382,800
Alaska2,6313763,100
Arizona1,33038438,400
Arkansas1,29349273,200
California1,062373,340,300
Colorado1,68822219,100
Connecticut1,21430242,900
Delaware1,7493561,400
District of Columbia1,9737176,300
Florida1,040391,231,100
Georgia1,13141735,800
Hawaii1,1092688,100
Idaho1,06932110,000
Illinois1,343341,035,200
Indiana1,31333496,100
Iowa1,45026167,000
Kansas1,21324158,200
Kentucky1,68340382,700
Louisiana85549509,300
Maine3,1363694,800
Maryland2,10731402,700
Massachusetts1,47431454,000
Michigan89033785,500
Minnesota1,93626322,500
Mississippi1,00650372,900
Missouri1,41040562,200
Montana1,8682254,900
Nebraska1,57534149,200
Nevada1,3802384,100
New Hampshire2,2762166,500
New Jersey1,53224455,900
New Mexico1,62351272,000
New York1,740341,653,200
North Carolina1,23326689,500
North Dakota1,3781931,500
Ohio1,16832902,200
Oklahoma1,20849438,700
Oregon1,47431249,200
Pennsylvania1,55928801,200
Rhode Island1,8633889,600
South Carolina1,26648452,300
South Dakota1,3003263,500
Tennessee1,12349694,500
Texas1,362321,557,500
Utah1,68718125,800
Vermont1,7764367,300
Virginia1,18923373,800
Washington1,06441575,700
West Virginia1,46445174,900
Wisconsin1,02526318,000
Wyoming1,2362933,900
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.

High-Cost Cases
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.

896 chart 1

896 chart 2

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.
2 Ibid.

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Publication Details

Publication Date: September 1, 2005
Citation:

EPSDT and Children's Coverage Costs, The Commonwealth Fund, September 2005

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