As New York's Medicaid program works to shift from fee-for-service to value-based payment models, the program cannot overlook its substantial number of child and young adult members, according to two new reports from the United Hospital Fund.
The not-for-profit policy group found that approximately 37% of the state's Medicaid enrollees in 2014 were under age 21, while 43.5% of the state's population under 21 is on Medicaid. That population represented just 20% of Medicaid expenditures during the year.
Although children are generally less expensive to treat, adverse experiences in early childhood can affect brain development and lead to greater risks of chronic illness later in life, according to Chad Shearer, director of the United Hospital Fund's Medicaid Institute and an author of the reports.
“Children's healthcare has some of the greatest opportunity for long-term impact on health,” Shearer said.
According to the reports, 90% of children on Medicaid had an average of $2,400 in annual expenditures per child, while only 10% of New York Medicaid's young population made up half of the program's expenditures on continuously enrolled children.
The UHF also found disparities in inpatient hospitalization and emergency department utilization rates among racial groups. Black and Hispanic children were much more likely to visit an emergency department or be admitted to a hospital than white, Asian or Pacific Islander children.
“New York Medicaid performs better than average on core quality measures, but there is room for improvement on many measures,” said Andrea Cohen, UHF's senior vice president for program. “Racial and geographic disparities in hospitalization rates for difference conditions also suggests areas for more work to improve overall childhood health.”
The fund noted that the state still seems to struggle to improve care for children with asthma in particular, but said this could be caused by several issues, including environmental factors, socio-economic conditions and clinical care issues. UHF encouraged the state to focus on preventive and respiratory treatment as well as behavioral health issues for adolescents.
Approximately 5% of children in New York were uninsured in 2014, according to data from the Kaiser Family Foundation. The state has placed a heavy focus on providing health insurance for children with Children's Medicaid and the state's Child Health Plus program, which charges no monthly premiums for families whose income is 1.6 times the poverty level or less.