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Acad Pediatr. 2019 Nov 5. pii: S1876-2859(19)30448-6. doi: 10.1016/j.acap.2019.10.014. [Epub ahead of print]

Children With Special Health Care Needs on Supplemental Security Income for Disability Have More Health Impacts and Needs Than Other Children With Special Health Care Needs on Medicaid.

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Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh (AJ Houtrow), Pittsburgh, Pa. Electronic address:
Departments of Pediatrics and Psychology, University of Cincinnati (A Carle), Cincinnati, Ohio.
Department of Pediatrics, Harvard Medical School and MassGeneral Hospital for Children (JM Perrin), Boston, Mass.
Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore (REK Stein), New York, NY.



The Supplemental Security Income (SSI) program for children with disabilities has come under recent public and political scrutiny. We sought to determine if children with special health care needs (CSHCN) on Medicaid/SCHIP who receive SSI for disability were more severely impacted by their health conditions compared to other CSHCN on Medicaid/SCHIP by comparing their health service utilization, markers of quality health care, and family impacts.


Using the 2009/2010 National Survey of CSHCN, we divided the population of CSHCN on Medicaid/SCHIP into 2 groups: CSHCN on SSI for disability and other CSHCN. We compared these 2 groups on measures of health condition severity, health service need and unmet need, health system quality measures, and family impact.


CSHCN on SSI had significantly higher adjusted odds of being affected by their health conditions, aOR = 4.33 (3.33-5.9) and having 2 or more functional difficulties, AOR = 3.38 (2.83-4.03). CSHCN on SSI had significantly higher health care needs but not higher unmet needs. The families of CSHCN on SSI experienced more work loss, aOR = 3.01 (2.52-3.59) and more financial problems, aOR = 1.68 (1.38-2.04).


This study indicates higher severity and extensive health service needs among CSHCN receiving SSI, compared to other low income children. CSHCN receiving SSI experience substantially more difficulty related to their health conditions and their conditions have considerably more impact on the daily lives of their parents.


Medicaid; Supplemental Security Income; children with disabilities; children with special health care needs


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