An estimated 11.2 million children, or 15% of all children in the U.S., have special health care needs, based on the most recent data available from 2009-2010. Their needs result from a range of conditions, such as Down syndrome, cerebral palsy, and autism. These children may require services such as nursing care to live safely at home, therapies to address developmental delays, and mental health counseling. This issue brief describes the role that Medicaid plays for children with special health care needs. It presents data comparing the health and functional needs, coverage adequacy and access to care, and affordability of coverage for Medicaid/CHIP children with special health care needs and those with private insurance. The Appendix includes state-level data on the distribution of children with special health care needs by household income, the share of children with special health care needs who are covered by Medicaid, and the share of Medicaid children with special health care needs who receive SSI.
Medicaid and CHIP cover nearly half (44%, or nearly five million) of children with special health care needs. Medicaid or CHIP is the sole source of coverage for over 1/3 (36%) of these children. Another 8% have Medicaid or CHIP to supplement their private coverage. Medicaid provides a wide range of medical and long-term care services, many of which are not covered at all or only available in limited amounts through private insurance, and makes coverage affordable for many children with special health care needs and their families.
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