Are Kids on Medicaid Adequately Served by Medical Specialists?

A study published in the New England Journal of Medicine found that children covered by Medicaid or the Children’s Health Insurance Program (CHIP) were less likely to be seen by specialists than their wealthier peers.

Researchers prepared two scripts for participants to use when they called 546 specialist clinics in Cook County, Illinois, home to Chicago and its surrounding suburbs. In one script, the callers, posing as mothers of sick children, reported symptoms of depression. In the other script, the callers described symptoms of type one diabetes.

Although neither speech volunteered information about insurance, callers were prepared to tell clinics they had either public insurance (Medicaid or CHIP) or private insurance. Participants made two calls over the course of a month using the same symptoms but changing the type of insurance they had.

Disturbing Pattern With a Potentially Serious Impact on Sick Children

What researchers found does not bode well for the nation’s poor, sick kids. Two thirds of the callers who claimed they had public insurance-either Medicaid or CHIP-were denied appointments, versus 11 percent of callers who claimed to have private insurance. For the publicly insured kids that did get appointments, the average wait time was 42 days, compared to 20 days for privately insured kids. Of 173 clinics that have licenses that allow them to accept public insurance, only 43 percent did.

The root of the problem may very well be the amount specialists are reimbursed for publicly insured kids. The average compensation a provider receives for a consultation with a publicly insured child is just shy of $100; for a privately insured child, however, providers receive an average of $160 per consultation.

This discrepancy has led to a large discrepancy in care. A report by the Connecticut Commission on Children found that children who live in poverty are five times more likely to die from infectious diseases than their wealthier peers. Kids in poverty also are more likely to have low birth weights and suffer from obesity and asthma.

The longer sick kids are denied care resulting in delayed diagnosis, the more serious their conditions can become. There are 37 million American kids on public insurance, so implications of the findings of the New England Journal of Medicine study may be huge. Until a more equitable policy is implemented, America’s neediest kids will continue to suffer.