Digging in on the Question of Access – Say Ahhh! A Children’s Health Policy Blog

As I mentioned last week, a chapter in the most
recent MACPAC report focuses on access to care for kids enrolled in
Medicaid and CHIP (the technical work was done by our friends at the
Urban Institute). The results are like those we’ve seen from other studies that
examine the issue – when compared to uninsured children, Medicaid/CHIP kids are
more likely to have a usual source of care, have had a well-child or specialist
visit in the past year, and are less likely to have delayed medical care. In
comparison to kids with ESI, the picture is a bit more complex, but overall,
their access and use of care is similar. Let’s delve into that complexity.

* Nearly all children with Medicaid and CHIP (95.5%) have
a usual source of care. For similarly situated children with ESI, 94.5% have a
usual source of care. The difference arises in where that usual source of care
is – for kids with Medicaid and CHIP, it’s more likely to be a clinic or a
health center; for those with ESI, it’s more likely to be a doctor’s office.

* Children with Medicaid and CHIP and those with ESI
report similar rates of delayed care. The difference comes about when you look
at why they delayed care. Kids with Medicaid/CHIP are less likely to delay care
because of out-of-pocket costs. While delays in care because families were
unable to make appointments during office hours were rare, they were more often
reported by children with Medicaid and CHIP. Perhaps a reason behind this disparity
may be that 42.9% of Medicaid/CHIP kids had a usual source of care with night
or weekend hours compared to 51.4% of kids with ESI.

* In terms of the timeliness of needed care and
appointments for routine care, as well as ease of obtaining needed care, tests,
and specialty care, there were no significant differences between those with
Medicaid/CHIP and similarly situated children with ESI. Parents of children in
Medicaid/CHIP reported rates of well-child visits and any office visit that
exceeded rates reported by children with ESI. The use of specialists among
children with Medicaid/CHIP was comparable to similarly situated children with

* A key difference is seen in their use of the emergency
room – kids with Medicaid/CHIP are more likely than uninsured children and
those with ESI to have had an emergency room visit. However, this may be due in
part to the fact that they have more limited access to evening and weekend
care, but additional research is needed on this topic.

Children in Medicaid and CHIP are more likely to be in
fair or poor health, have asthma, or have physical, mental, or emotional
limitations, than children covered by ESI or children who are uninsured.
They’re also more likely to be in families with incomes below the federal poverty
level than either uninsured or ESI-covered children. Such differences can
influence how children access care. So in order to determine how access and use
of care differ based on type of coverage, all of the above comparisons looked
at similarly situated kids by controlling for underlying characteristics of the
children and their families.

There were a few cases in which the results differed when
these controls were not used, suggesting that factors beyond coverage – such as
health status, race/ethnicity, and family income – are associated with
differences in access to care. In some cases, such as delaying care and
difficulty accessing specialty care, challenges exist for certain types of
children whether they have ESI or Medicaid/CHIP.

Next up on the Commission’s docket in terms of access are
an extension of this work to non-elderly adults and a more in-depth look at
particular issues for children’s access, including oral health, geographic
variation by state and rural/urban location, and the influence of payment

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