Medicaid and CHIP covered about half (48%) of all children with special health care needs in 2016. This issue brief describes the role that Medicaid plays for children with special health care needs and includes 50-state data on children with special health care needs covered by Medicaid/CHIP. Key findings include the following: (1) Less than one in five (19%) children with disabilities receives Medicaid because they also receive federal Supplemental Security Income (SSI) benefits. Other Medicaid coverage pathways for children with disabilities are offered at state option. Reflecting different state policy choices, the share of children with special health care needs covered by Medicaid/CHIP varies by state from 23% to 67%. (2) Medicaid's benefit package for children, Early and Periodic Screening Diagnostic and Treatment, covers physical and behavioral health services as well as long-term care services that enable children with chronic needs to live at home with their families. Medicaid supplements special education services and fills in coverage gaps for privately insured children with special health care needs. (3) Annual per enrollee spending is over seven times higher for Medicaid children who qualify through a disability pathway ($17,831) compared to those who qualify through another pathway, such as family income ($2,484) as of 2013. This reflects the greater intensity and variety of needs among most children who qualify based on a disability compared to most children who qualify through another pathway. Legislative proposals that would reduce and cap federal Medicaid funding may pose a particular risk to children with special health care needs. While Congress did not pass such legislation in 2017, similar proposals could be considered in 2018, and the Trump Administration's FY 2019 proposed budget continues to advance these proposals.
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