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Medicaid’s Role for Children with Special Health Care Needs: A Look at Eligibility, Services, and Spending

Issue Brief
  1. Kaiser Family Foundation analysis of the 2017 National Survey of Children’s Health, Topical File.

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  2. U.S. Dep’t of Health & Human Services, Health Resources & Services Administration, Maternal & Child Health, Children with Special Health Care Needs (Date Last Reviewed: March 2019), https://mchb.hrsa.gov/maternal-child-health-topics/children-and-youth-special-health-needs#ref1.

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  3. Tenn. General Assembly, Conference Committee Report on H.B. 1280/S.B. 1428 (May 17, 2019), http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB1280.

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  4. Kaiser Family Foundation, Medicaid Financing: The Basics (March 2019), https://www.kff.org/medicaid/issuebrief/medicaid-financing-the-basics/.

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  5. It may not be possible to easily identify all of these children in the Medicaid administrative data, based on their service use.

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  6. Louisiana, which currently has a Katie Beckett-like waiver, has passed legislature in both houses to adopt the Katie Beckett state plan option. La. H.B. 199 (2019 Regular Session), http://www.legis.la.gov/legis/BillInfo.aspx?s=19RS&b=HB199&sbi=y.

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  7. Tennessee’s Section 1115 waiver currently covers “medically eligible” children” in households with income at or above 211% FPL with no asset test, although enrollment in this pathway is closed except for rollovers from those losing coverage in a traditional group. CMS, TennCare II Special Terms and Conditions, #11-W-00151/4 at paragraph 20 and Table 1a (Dec. 16, 2016-June 30, 2021), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/tn/tn-tenncare-ii-ca.pdf. Those with income less than 211% FPL are covered with CHIP funds. Tennessee’s Section 1115 waiver also provides Medicaid HCBS to a capped number of children up to age 21 with intellectual or developmental disabilities who meet or are at risk of meeting an institutional level of care with incomes up to 300% SSI. Id. at paragraph 22 (f), p. 36 and Table 2c.

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  8. Tenn. General Assembly, Amendments No. 1-1 and 2 to H.B.0498, http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB0476.

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  9. This share is based on data from the National Health Interview Survey which does not identify whether children are eligible for Medicaid in a poverty-related pathway vs. a disability-related pathway, and may be a conservative estimate of the total number of children with SSI. The Social Security Administration reports about 1.2 million child SSI beneficiaries in 2017. Social Security Administration, SSI Annual Statistical Report, 2017, Table 7 (released Sept. 2018), https://www.ssa.gov/policy/docs/statcomps/ssi_asr/2017/sect02.html#table7. These two sources report differ numbers due to differences in underlying data collection methods, but the difference does not change the overall conclusion that most Medicaid children with special health care needs do not qualify through a disability-related pathway.

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  10. For example, MSIS data show 34.8 million Medicaid children eligible based on low family income as of 2014, and 1.6 million Medicaid children eligible based on a disability (including SSI, Katie Beckett, HCBS waivers, and other disability-related pathways) as of 2011.

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  11. Tenn. General Assembly, Conference Committee Report on H.B. 1280/S.B. 1428 (May 17, 2019), http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB1280.

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  12. Kaiser Family Foundation, Medicaid Financing: The Basics (March 2019), https://www.kff.org/medicaid/issuebrief/medicaid-financing-the-basics/.

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