Financial burden of raising CSHCN: association with state policy choices.
OBJECTIVE
We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN).


METHODS
Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics.


RESULTS
Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden.


CONCLUSIONS
Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits.
Parish
Susan L
SL
School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA. parish@unc.edu
Shattuck
Paul T
PT
Rose
Roderick A
RA
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics*; D002669:Child Welfare / Q000191:economics; D002675:Child, Preschool; D017281:Cost of Illness; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D004608:Eligibility Determination; D005260:Female; D005382:Financing, Personal / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D016014:Linear Models; D008297:Male; D008484:Medicaid / Q000191:economics; D015999:Multivariate Analysis; D011203:Poverty / Q000706:statistics & numerical data; D011640:Public Policy; D014481:United States