Analysis Examines Insurance Coverage, Affordability and Access to Home and Community-Based Services for Children with Special Health Care Needs

A new KFF analysis examines key characteristics of children with special health care needs, the affordability and adequacy of their health coverage, and the implications for such children of potential new federal Medicaid money to assist families in caring for them.

Medicaid is a significant source of coverage for medical, behavioral health, and long-term services and supports for children with special health care needs, including home and community-based services (HCBS) that they need to live at home with their families. During the pandemic, children have experienced health care disruptions, mental health challenges, and economic hardships, and these issues may have been intensified for those with special health care needs.

The American Rescue Plan Act provides a temporary increase in federal Medicaid matching funds for state spending on HCBS. As part of the budget reconciliation legislation, the House currently is considering $190 billion in additional Medicaid HCBS funding that states could use to support the HCBS provider workforce, offer new or expanded HCBS benefits, and/or serve more HCBS enrollees, though the final funding amount has not yet been set.

The analysis provides context for those ongoing policy discussions. Key findings include:

• Medicaid/CHIP covers almost half of the 13.9 million children in the U.S. with special health care needs, though the share varies by state.

• Children with special health care needs covered by both Medicaid/CHIP and private insurance have the greatest health care needs, and children who are covered only by Medicaid/CHIP are more likely to have greater health needs compared to those with private insurance only.

• While families of Medicaid/CHIP-only children with special health care needs are more likely to face financial difficulty, they find their health care more affordable than those with private insurance only. This is due to Medicaid’s cost-sharing protections.

• Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs.

For the full analysis, as well as other data and analyses about health care priorities in the budget reconciliation discussion on Capitol Hill, visit kff.org.