Preventing Chronic Disease | State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits - CDC
State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits
William S. Pearson, PhD, MHA; Scott A. Goates, PhD; Samantha D. Harrykissoon, JD, MPH; Scott A. Miller, MPA
Suggested citation for this article: Pearson WS, Goates SA, Harrykissoon SD, Miller SA. State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits. Prev Chronic Dis 2014;11:140139. DOI: http://dx.doi.org/10.5888/pcd11.140139
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Abstract
Introduction
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.
Methods
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.
Results
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.
Conclusions
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.
Acknowledgments
All work was conducted by employees of CDC and no outside funding was received for this work.
Author Information
Corresponding Author: William S. Pearson, PhD, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-02, Atlanta, GA 30329. Telephone: 404-639-6459. E-mail: Wpearson@cdc.gov.
Author Affiliations: Scott A. Goates, Samantha D. Harrykissoon, Scott A. Miller, Centers for Disease Control and Prevention, Atlanta, Georgia.
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