Posted by: Schuyler R. Thorpe | June 27, 2011

Sick Kids In America Denied Medical Care Under Medicaid

(It’s worse for the homeless and the poor.)

Sick kids on Medicaid wait much longer for care

BOSTON (Reuters Health) – Sick children covered by Medicaid or the Children’s Health Insurance Program (CHIP) must wait twice as long as youngsters with private insurance to get an appointment with a specialist — if they can get one at all, according to a new study.

Although past research has shown a disparity in care for people covered by public versus private health insurance, this is the first study to take a comprehensive look at specialty care for children, said co-author Dr. Karin Rhodes of the University of Pennsylvania.

“We had an idea this was a problem, but we didn’t know the magnitude of it,” she told Reuters Health.

The study looked at a few hundred specialty clinics in Illinois and was reported in the June 16 edition of New England Journal of Medicine. It represents “clear and convincing evidence” that children with public insurance are treated differently and “it’s across the system,” said Rhodes.

Federal law says Medicaid recipients must have the same access to care as the general population.

During the first five months of 2010, female callers posed as mothers whose child was in need of specialty care for a serious condition such as severe depression, diabetes or seizures.

They contacted 273 specialty clinics in Cook County, Illinois, asking for an appointment. At one point they said they had private insurance; at another, they offered an identical scenario but said the child had Medicaid or CHIP coverage.

While care was denied at only 11 percent of the clinics when private insurance coverage was offered, the denial rate was 66 percent when the clinic was told the child was covered by public insurance.

In cases where Medicaid-CHIP insurance was accepted, the children were told they would have to wait, on average, 22 days longer than peers covered by private insurance.

The typical wait for an appointment was 20 days in the private coverage group and 42 days for Medicaid-CHIP.

That trend was seen across all seven specialties tested — orthopedics, psychiatry, asthma, neurology, endocrinology, otolaryngology and dermatology.

Rhodes and co-author Joanna Bisgaier, also of the University of Pennsylvania, selected conditions that were “very common and where there’s evidence that specialty intervention can make a difference in long-term outcome,” Rhodes said.

One woman who called seeking treatment for a child’s newly-diagnosed type 1 diabetes was told the wait would be one year.

Even for children with private insurance — who could get an appointment, on average, after 20 days — “just having to wait three weeks with a kid with a new onset seizure, or diabetes, or poorly controlled asthma, or a fracture, is disturbing in itself,” Rhodes said.

“You add an extra 22 days on to that, and what you’ve got is disparities, discrimination that is purely based on insurance,” she said.

Rhodes said other states should consider doing a similar test, particularly if they are thinking of scaling back public insurance programs to save money.

“Every state should be studying their access, particularly if they’re considering cuts to Medicaid because they’re cash-strapped and they think they’re going to take it out of their healthcare budget,” she said. “If we keep whittling away at these programs, we will increase the disparities.”



  1. The only way of fixing that is to, after decades of it stagnating, updating the Medicaid Reimbursement Schedule.which currently pays doctors less than what many of the procedures actually cost to perform. This is especially true in the case of various specialties such as those listed.

    There’s a reason why a small and dwindling percentage of doctors even accept Medicaid and CHIP patients…

    Of course, if the reimbursement schedule is updated the costs of the programs will likely become prohibitive.

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