Characterize healthcare utilization among Medicaid-enrolled children and quantify use and spending across preventive, chronic, and nonchronic care, clinical conditions, and care settings.
Approach:
Design and population: Retrospective analysis of 2022 Medicaid Marketscan data for children younger than 20 years enrolled for any duration across 12 states.
Classification and analysis: Claims were categorized by principal diagnosis using PECCS, classified as preventive, chronic, or nonchronic care, and grouped by outpatient, inpatient, pharmacy, or emergency setting. Spending was standardized to fee-for-service claims.
Key Findings:
The study included 7.2 million children; 78.5% had at least one Medicaid claim, while 21.5% had none.
Total expenditures were $22.3 billion. Outpatient care accounted for 55.2% of spending, inpatient care 25.2%, pharmacy 13.9%, and emergency services 5.8%.
Preventive care was used by about 50% of healthcare utilizers and accounted for 8.5% of spending.
Chronic-condition care was used by about 27% of utilizers and accounted for 41.1% of spending; nonchronic care was used by nearly 70% and accounted for 50.4%.
Outpatient services represented 88.5% of preventive-care spending, 64.4% of chronic-care spending, and 42.1% of nonchronic-care spending.
Interpretation:
In this 12-state 2022 Medicaid dataset, spending shares differed across preventive, chronic, and nonchronic care and across service settings.
Limitations:
The database lacked a state identifier, and the validity of race data could not be evaluated because race collection and standardization may vary by state.
Plan type was assigned from enrollment records rather than individual claims.
For claims without a principal diagnosis, the last diagnosis carried forward was used for imputation.
