Medicaid Budget Cuts: Will They Adversely Impact the Health of Medicaid-Covered Children?

Introduction: The 2005 Deficit Reduction Act called for reduction of Medicaid benefits and increased patient cost sharing through co-payments and premiums. The impact of these changes on Medicaid recipients is unclear. Objectives: To assess perceptions of parents of Medicaid-covered children regarding the potential impact of Medicaid reform on children's health care. Methods: Ethnographic interviews of parents of Medicaid-covered children attending an urban pediatric clinic. Parents were asked 40 questions to assess knowledge, beliefs, attitudes, and intended behaviors related to Medicaid reform. Results: The 49 interviewed parents had a median age of 28 years; 90% were African-American; 64% were high school graduates; and 41% had children with chronic conditions. Most parents were unaware of Medicaid reform, and the remainder were confused about reform. Although a few parents stated that the changes were reasonable, most parents did not. Financial hardship was cited as a major consequence of reform, leading to increased use of government entitlement programs, increased debt, and possibly bankruptcy. One mother stated, “What was the purpose of being on Medicaid if you could afford to pay for it?” Parents also expressed concern about sacrifices they would have to make to pay co-payments. “I probably wouldn't be able to pay rent, probably wouldn't be able to get food…If that was added, we would probably be on the street.” Other sacrifices included taking additional jobs, working longer hours, and cutting back on medication for themselves. In response to co-pays and premiums, parents would defer needed preventive care for children; defer sick care; increase their reliance on charity care; and increase use of EDs. Many parents expressed concern that the changes would negatively impact the overall well being of their family, “With three children, I'm already struggling, you know, just to make ends meet…I think that would be terrible if I have to cut back on their health care just because I can't afford it.” Conclusions: Parents of Medicaid-covered children report that current Medicaid reform will result in increased financial and non-financial hardship; deferral of preventive and sick care for children; increased reliance on charity care; increased ED visits; and decreased health and well being for children and families. These findings suggest that Medicaid reform could cause less continuity of care, greater unmet healthcare needs, greater societal burden, and higher future healthcare costs.