Medicaid utilization in children: Condition-specific incidence and spending.

Abstract

Medicaid insures over half of US children, yet gaps remain in understanding how funds are allocated across the care of nonchronic conditions, the care of chronic conditions, and preventative services. We conducted a retrospective analysis of 7.2 million Medicaid-enrolled children from 12 states in the 2022 Medicaid Marketscan database. Only 78.5% of enrolled children had a Medicaid healthcare claim. Among those with at least one Medicaid claim, half received preventative care, accounting for just 8.5% of total Medicaid spending. Care of nonchronic conditions accounted for the highest proportion (50.4%) of spending, while the care of chronic conditions affected 27.7% of children and represented 41.1% of spending. These findings highlight opportunities for preventive care and the need for strategies to increase access and optimize Medicaid's impact on children's health.