Cutting Insurance Eligibility Ups Peds Hospitalization Cost Burden

FRIDAY, July 13, 2018 — Reducing public insurance (Medicaid and the Children’s Health Insurance Program) income eligibility limits would result in large numbers of newly ineligible pediatric hospitalizations, according to a study published online July 9 in Pediatrics.

Jessica L. Bettenhausen, M.D., from the University of Missouri-Kansas City, and colleagues conducted a retrospective cohort study using the 2014 State Inpatient Databases for all pediatric (age, <18) hospitalizations in 14 states. Each patient’s zip code was linked to the American Community Survey to ascertain the likelihood of the patient being below three different public insurance income eligibility thresholds (300, 200, and 100 percent of the federal poverty level [FPL]).

The researchers found that reductions in eligibility limits to 300, 200, and 100 percent of the FPL would have resulted in large numbers of newly ineligible hospitalizations (20, 57, and 84 percent of hospitalizations, respectively), corresponding to $1.2, $3.1, and $4.4 billion of estimated child hospitalization costs among 775,460 publicly reimbursed hospitalizations in 14 states. Only slight differences were seen in patient demographics under each eligibility threshold.

“Reducing public insurance eligibility limits would have resulted in numerous pediatric hospitalizations not covered by public insurance, shifting costs to families, other insurers, or hospitals,” the authors write. “Without adequately subsidized commercial insurance, this reflects a potentially substantial economic hardship for families and hospitals serving them.”

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Posted: July 2018

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