Children with medical complexity and medicaid: Spending and cost savings

Jay G. Berry, Matt Hall, John Neff, Denise Goodman, Eyal Cohen, Rishi Agrawal, Dennis Kuo, Chris Feudtner

Research output: Contribution to journalArticlepeer-review

173 Scopus citations


A small but growing population of children with medical complexity, many of whom are covered by Medicaid, accounts for a high proportion of pediatric health care spending. We first describe the expenditures for children with medical complexity insured by Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for these children, relative to the small amount of primary care and home care spending. We then present a business case that estimates how cost savings might be achieved for children with medical complexity from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.

Original languageEnglish (US)
Pages (from-to)2199-2206
Number of pages8
JournalHealth Affairs
Issue number12
StatePublished - 2014

ASJC Scopus subject areas

  • Health Policy


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