title: Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009-2010.
abstract: OBJECTIVE
  To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009-2010 and assess changes since 2001.
  
  
  METHODS
  Data were from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a random-digit telephone survey with 40,243 (2009-2010) and 38,866 (2001) completed interviews. Consistency and adequacy of insurance was measured by: 1) coverage status, 2) gaps in coverage, 3) coverage of needed services, 4) reasonableness of uncovered costs, and 5) ability to see needed providers, as reported by parents. Bivariate and multivariable analyses were conducted to assess factors associated with adequate insurance coverage in 2009-2010. Unadjusted and adjusted prevalence estimates were examined to identify changes in the type of insurance coverage and the proportion of CSHCN with adequate coverage by insurance type.
  
  
  RESULTS
  The proportion of CSHCN with private coverage decreased from 64.7% to 50.7% between 2001 and 2009-2010, while public coverage increased from 21.7% to 34.7%; the proportion of CSHCN without any insurance declined from 5.2% to 3.5%. The proportion of CSHCN with adequate coverage varied over time and by insurance type: among privately covered CSHCN, the proportion with adequate coverage declined (62.6% to 59.6%), while among publicly covered CSHCN, the proportion with adequate insurance increased (63.0% to 70.7%). Publicly insured CSHCN experienced improvements in each of the 3 adequacy components.
  
  
  CONCLUSIONS
  There has been a continued shift from private to public coverage, which is more affordable, offers benefits that are more likely to meet CSHCN needs, and allowed CSHCN to see necessary providers.
authors: US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Division of Epidemiology, Rockville, Md. Electronic address: rghandour@hrsa.gov.
authors: Reem M
authors: RM
authors: Ghandour
authors: Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
authors: Meg
authors: M
authors: Comeau
authors: Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
authors: Carol
authors: C
authors: Tobias
authors: Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
authors: Beth
authors: B
authors: Dworetzky
authors: Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
authors: Rose
authors: R
authors: Hamershock
authors: Family Voices, Washington, DC.
authors: Lynda
authors: L
authors: Honberg
authors: Division of Services for Children With Special Health Care Needs, Rockville, Md.
authors: Marie Y
authors: MY
authors: Mann
authors: Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
authors: Sara S
authors: SS
authors: Bachman
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D012189:Retrospective Studies; D014481:United States
keywords: Affordable Care Act; children with special health care needs; health insurance adequacy; trends