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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 2016 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 (Dec. 2016), https://mchb.hrsa.gov/maternal-child-health-topics/children-and-youth-special-health-needs#ref1.

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  3. 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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  4. 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 2016. Social Security Administration, Annual Statistical Supplement to the Social Security Bulletin (2017), Table 7.A9 (preliminary data), https://www.ssa.gov/policy/docs/statcomps/supplement/2017/7a.html#table7.a8.  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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  5. 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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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.