P2A043: Effect of Covid 19 on Adequate Transition from Pediatric to Adults for Children with Special Health Care Needs: A Comparatively Analysis Among States Who Adopted Medicaid Expansion vs States Who Hasn't Adopted the Medicaid Expansion

Background: An estimated 14.2 million children in the U.S., have special health care needs (CSHCN) and 5 million of these children need to transition from a pediatric-based to an adult-based health care setting yearly. To have ‘’Adequate transition’’ a CSHCN must have been spoken to by a doctor with the child privately without an adult in the room during the last medical care visit, or if a discussion about transitioning to adult care was needed, it must have happened, and doctors actively worked with child to gain skills and understand changes in their health care. If a child has at least one valid positive response to any of these components, then the child has been adequately transitioned. Based on the National Child Health Survey (NCHS) of 2021 79% of these children reported ‘’inadequate transition’. Insurance transition is a big challenge at this time of transition which was interrupted more during Covid 19 pandemic.
In this study we investigated the impact of Medicaid expansion in the transition of care for CSHCN, focusing on the effect pre and post covid-19 pandemic by analyzing NCHS 2016-2021.

Methods: Data were obtained from the NCHS, an annual serial cross-sectional survey were examined from 2016 to 2021; for fifty states and District of Columbia. The status of each state was verified through the Kaiser Family Foundation database for Medicaid expansion. We used a repeated measures logistic regression model looking at the outcome of transition to adequate care, and the predictors of Medicaid expansion, covid, and an interaction term between the two. The interaction term was there to test whether there was a difference in the rate of adequate care at transition for states who expanded Medicaid during covid. We used General Estimating Equations to account for within state factors and used an exchangeable correlation structure.

Results: While both covid and Medicaid expansion had been significant in our model without interaction, the interaction term did not show a statistically significant difference in the rate of adequate care at transition during covid. However, Medicaid expansion was related to a 33% increase in the rate of adequate care at transition, over states without expansion (OR: 1.33, 95% CI: 1.016 - 1.647, p = 0.016).

Conclusion: The Affordable Care Act, through its Medicaid expansion, led to increased health insurance enrollment and access to care, including those with disabilities. Medicaid plays a key role for CSHCN and improves transition of care. The effect, though not statistically significant when comparing pre and post pandemic era, states with Medicaid Expansion did better in terms of adequate transition than states without Medicaid expansion.