Overcoming Unstable Insurance Coverage for Ohio Kids with Special Health Care Needs

A third of Ohio children with special health care needs have unstable or inadequate insurance coverage despite the fact that they may qualify for government health programs.

Our Child Policy Research Center has analyzed data about Ohio children with special health care needs (CSHCN).  Some 445,200 children, or 16.2 percent of all Ohio children, meet the screening criteria to be classified as having special health care needs (i.e. functional limitations, emotional, behavioral and development needs, access to specialized therapies).  While data indicate that these kids are more likely to be insured than not, nearly 12 percent of the poorest CSHCN did not have consistent access to health insurance over the course of the study year, 2005/2006.

Thirty-one percent of these families who have private insurance face what they consider “unreasonable” health care costs.  While many of us might say our health care costs are unreasonable too, consider this: average out-of-pocket expenses for a privately insured child with special health care needs are nearly three times higher than those of non-CSHCN.  Families of uninsured CSHCN face out-of-pocket costs nearly five times higher than uninsured children without special health care needs.  It is no wonder that 45 percent of uninsured families of CSHCN are having financial problems from the cost of care; fifteen percent of insured families also are struggling.

Families are working to combat the problem, but at great costs, both personally and financially.  About one-quarter of uninsured or inadequately-insured families find themselves in a situation where one family member must cut back hours, or leave the workplace altogether, in order to care for their child’s health needs.  This ultimately creates a tremendous financial strain and leaves some families contemplating delaying or avoiding preventive treatment, which potentially can lead to even greater health care costs down the road.

A complete solution is not plausible at this time.  However, the passage of health reform aims to close gaps in insurance coverage; for example, it will no longer be permissible to exclude these children with pre-existing conditions from private health coverage.

We can begin now by educating uninsured families caring for CSHCN of their health care options – two out of every three are eligible for current public programs.  Enhanced efforts to enroll and retain all Medicaid-eligible children would capture some of those under- or uninsured, and potentially help reduce additional high costs engendered to their families and the health care system.

Quality of care for all children is important, but quality of care for these kids is critically important.  When public or private health insurance is interrupted or inadequate, it takes a toll on the child, but also on that child’s family, healthcare provider and the state’s economy.

Gerry Fairbrother, PhD, is the Associate Director of the Child Policy Research Center. Her research focuses on access and barriers to care, particularly for low-income children, and vaccine policies. Dr. Fairbrother also directs the Health Services Research course in the Division of Epidemiology and Biostatistics at the University of Cincinnati.

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  1. Chris Lah August 28, 17:18
    Gerry -like the article. I am currently over both CCHMC's financial counselors and financial advocates. My staff is very interested in your research on this topic and I shall share.