297 - Trends in Prevalence and Healthcare Spending for Children with Complex Chronic Conditions using Medicaid (2012-2021)

Poster Number: 297
Publication Number: 297.205

Background: Despite low population prevalence, children with complex chronic conditions (CCCs) account for disproportionately high healthcare use and costs. Advances in care and treatments over time may have led to increasing prevalence, as well as changes in expenditures, for children with CCCs.

Objective: To assess trends in prevalence and healthcare spending of children with CCCs.

Design/Methods: RRetrospective analysis of 23,162,953 children ages ≤18 years continuously enrolled in Medicaid in 10-to-12 U.S. states contained in the Medicaid MarketScan Database from years 2012 through 2021. CCCs - conditions with high morbidity and mortality expected to last 12 months and require specialty care - were identified with ICD diagnosis codes using Feudtner’s classification system. Trends in healthcare spending by category of health service was assessed with the Cochran–Armitage test for trend using inflation-adjusted U.S. dollars with percentage of total spending and as per member per year (PMPY) spending.

Results: Over the 10-year study period, the prevalence of children with 1 CCCs stayed constant over the study period (5.6% in 2012; 5.3% in 2021).The percentage of total Medicaid spending attributable to children with 1 CCC increased by 4.6% points [from 35.6% (2012) to 40.2% (2021), p<.001]. Among children with 1 CCC, allocation of spending decreased for primary care (from 2.6% to 2.0%, p<.001) and inpatient care (57.6% to 45.1%, p<.001.) Among children with 1 CCC, allocation of spending from 2012 to 2021 stayed similar for emergency department care (2.1% to 1.9%), while spending allocation increased for medications (8.6% to 19.1%, p<.001) and home health care (1.3% to 4.5%, p<.001). In 2021, PMPY spending on children with 1 CCCs was smallest for primary care ($516) and dental care ($433), and greatest for home health ($24,823) and inpatient care ($44,057).

Conclusion(s): Although the prevalence of children 1 CCCs was constant over the last ten years, the proportion of Medicaid spending attributable to these children increased. Further investigation is necessary to distinguish the best balance of health service spending for children 1 CCCs to optimize their health and wellbeing.