Home Health Care Utilization in Children With Medicaid

Abstract

BACKGROUND: Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. METHODS: We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality’s Chronic Condition Indicators and Feudtner’s Complex Chronic Conditions. RESULTS: Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. CONCLUSIONS: Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

Children with medical complexity receiving home healthcare devices in Japan: a retrospective cohort study

“…In terms of international comparison, the male-to-female ratio (53.7:46.3) was comparable with previous similar studies from the USA, where children used home healthcare in the Medicaid cohort (54.5:45.5) 3 and Canada, where children in Ontario with medical complexity had a ratio of 55.4:44.6. 2 From the available data, we found that (1) the crude incidence rate of children receiving home mechanical ventilation in Japan (4.1 per 100 000 children; online supplemental eTable 1 ) was higher than that in Canada (2.9 per 100 000 children) and (2) there was an increasing trend of these children in both Canada and Japan.…”

“…Recent efforts have attempted to reveal important information regarding CMC from various perspectives, including home healthcare use, 3 evaluation of care coordination/programmes 4 5 , medication safety 6 and their caregivers. 7 8 However, evidence remains inadequate for these children, especially children receiving home healthcare devices (HHDs).…”

Employment and leave while parenting children with medical complexity.

“…Frameworks used to define medical complexity for children include severity and number of complex chronic conditions, functional limitations, and health-care needs among other factors (Berry, Agrawal, et al, 2011). Addressing the multifaceted needs of these medically high-risk children entails frequent care from a spectrum of primary and subspecialty providers, in addition to at-home care (Perrin, 2002; Sobotka et al, 2022).…”