This project (U1TMC31757) is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $500,000, with no financing by nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government; HRSA Project Officer Sarah Beth McLellan.

Tips for Using the Data

This page outlines how to understand, interpret and use the data accurately. Chartbook users should be alert to two general points about the date:
  • 1. Comparable vs. Current

    Because we want to permit comparisons across states, we have tried to use data items that are defined and gathered consistently across states. As a result, some of the data presented may not be the most current data available for a particular state on a particular issue, but are the most current data available for all states on that issue. When sharing information about a single state, it may make sense to update particular items for which more timely, state-specific data are available. When comparing multiple states, however, we encourage you to use the data presented here, or turn to the sources of those data.
     
  • 2. A Caution on Comparisons

    There are data elements which, despite having been defined and gathered consistently, reflect substantial state-to-state differences in consumer attitudes or expectations. We try to indicate those items, and encourage caution in making state-to-state comparisons on those points.

Caution!Caution! Points like this, which highlight possible pitfalls in using particular data elements, are marked with this icon.

Demographics

Economics

Child Health Services

Factors Influencing Health Insurance Coverage

Title V Program

Experience with the System of Care for CSHCN

COVID-19

The makeup of a state’s population is the starting place for understanding health needs.

Child Population

Total child population is the backdrop for understanding the size of the CSHCN population. Note this data source represents children ages 0-18 while the 2018-2019 NSCH data represent children ages 0-17.

US total population of children excludes Puerto Rico.

Race/Ethnicity

Percentage of children, by race/ethnicity
Children are ages 0-18. Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.

Special Health Care Needs

These figures reflect parent responses to "screener" questions about the child's use of or need for services. Learn more about the screener at http://www.cahmi.org/projects/children-with-special-health-care-needs-screener/
Percentage of children 0-17 who have special health care needs
CSHCN Status is determined using a validated instrument for identification of children with special health care needs as defined by the federal Maternal and Child Health Bureau. The CSHCN Screener asks whether a child currently experiences a health consequence and, if so, whether that specific health consequence is due to a medical, behavioral, or other type of health condition that has lasted, or is expected to last, 12 months or longer.
Percentage of children with reported special health care needs, by age group
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of children with reported special health care needs, by sex
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Percentage of children with reported special health care needs, by race/ethnicity
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about coverage and financing strategies that address inequities https://ciswh.org/project/the-catalyst-center/financing-strategy/inequities/.
Percentage of children with reported special health care needs, by primary household language
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about coverage and financing strategies that address inequities here .
Percentage of children with reported special health care needs, by household income
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about coverage and financing strategies that address inequities here .
Percentage of children with reported special health care needs, by number of functional difficulties
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.

This measure was scored as the count of difficulties children experience from a list of 12 functional difficulties, which do not include behavioral or mental health difficulties. The difficulties are asked about as two different types of questions: (a) During the past 12 months, whether the child had frequent or chronic difficulty with breathing or other respiratory problems; eating or swallowing; digesting food, including stomach/intestinal problems, constipation, or diarrhea; repeated or chronic physical pain, including headaches or other back or body pain; using his/her hands (0-5 years); coordination and moving around (0-5 years) , and (b) Whether the child has serious difficulty concentrating, remembering, or making decisions (6-17 years); serious difficulty walking or climbing stairs (6-17 years); difficulty dressing or bathing (6-17 years); difficulty doing errands alone, such as visiting a doctor’s office or shopping (12-17 years), deafness or problems with hearing; and blindness or problems with seeing, even when wearing glasses.
Percentage of children with reported special health care needs, by number of qualifying criteria on the CSHCN screener
CSHCN Status is determined using a validated instrument for identification of children with special health care needs as defined by the federal Maternal and Child Health Bureau. The CSHCN Screener asks whether a child currently experiences a health consequence and, if so, whether that specific health consequence is due to a medical, behavioral, or other type of health condition that has lasted, or is expected to last, 12 months or longer.
Percentage of children with special health care needs, by type of CSHCN screener qualifying need
CSHCN Status is determined using a validated instrument for identification of children with special health care needs as defined by the federal Maternal and Child Health Bureau. The CSHCN Screener asks whether a child currently experiences a health consequence and, if so, whether that specific health consequence is due to a medical, behavioral, or other type of health condition that has lasted, or is expected to last, 12 months or longer.

Low Birth Weight

Percentage of live births that are low birth weight (all races)
Low birth weight is defined as newborn weight below 2500 grams (about 5 lbs).
Percentage of live births that are low birth weight by race/ethnicity
Low birth weight is defined as newborn weight below 2500 grams (about 5 lbs).

Special Education

Percentage of public school students enrolled in Special Education
Caution! Age group of children served is 3 to 21-year-olds.

Income

Median Annual Household Income
In 2019 inflation-adjusted dollars. Data are limited to the household population and exclude the population living in institutions, college dormitories, and other group quarters. For information on confidentiality protection, sampling error, nonsampling error, and definitions, click here .
Percentage of CSHCN in families with income below 200% of the federal poverty level
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of children living in a household receiving food or cash assistance at any time during the past 12 months
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of CSHCN living in a household receiving food or cash assistance at any time during the past 12 months
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.

Education

Highest level of education in families raising non-CSHCN
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Highest level of education in families raising CSHCN
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information, click here.

Employment

Unemployment rate
The unemployment rate measures unemployment within the civilian non-institutional population aged 16 years and older. Data refer to place of residence and are seasonally adjusted.
Percentage of families raising non-CSHCN who reported a family member avoided changing jobs because of concerns about maintaining health insurance for their child in the past 12 months
Percentage of families raising CSHCN who reported a family member avoided changing jobs because of concerns about maintaining health insurance for their child in the past 12 months

Financial Impact of Caregiving

Percentage of families raising CSHCN who report they have stopped working or reduced work hours as a result of their child’s health condition(s), in the lat 12 months
Learn more about the coverage and financing of relief funds at https://ciswh.org/project/the-catalyst-center/financing-strategy/relief-funds/
Percentage of families who report they have stopped working or reduced work hours as a result of their child’s health condition(s) in the past 12 months, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on the CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Percentage of families raising CSHCN who paid out-of-pocket medical expenses for their child, by amount
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Out of pocket costs include co-pays and amounts from Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), for medical, health, dental, and vision care during the past 12 months. This does not include premiums.
Percentage of families raising CSHCN who report problems paying for the child's health care bills
Caution! Interpret with caution because for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Families raising CSHCN are more likely to experience housing instability (Rose-Jacobs, Cuba, Bovell-Ammon, Black, et al., 2019), difficulty paying utility and phone bills, and food insecurity (Stoddard-Dare, DeRigne, Quinn, & Mallett, 2015) than families who are not raising CSHCN. The data here focuses on problems paying for a child’s health care bills, but may not be an adequate indicator of financial hardship or well-being among families raising CSHCN because paying a child’s health care bills may be prioritized over other expenses (Allshouse, Comeau, Rodgers, & Wells, 2018; Bachman & Comeau, 2010).
Percentage of families who report problems paying for their child's health care bills, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.

Medicaid Eligibility

Although they must meet or exceed a federally set standard, states have substantial discretion in setting income limits on Medicaid eligibility. States with higher maximum income limits cover a broader population.
Maximum allowed income for Medicaid enrollment, as a percentage of the federal poverty level, compared to the federal minimum requirement
Caution! Children's Medicaid eligibility includes Title XXI CHIP funding for states that expanded Medicaid with CHIP funds. All eligibility limits reflect the MAGI-converted income standards, which includes the five percentage point disregard applied to the upper limit for Medicaid coverage for each group.
Learn about the coverage and financing of Medicaid Buy-Ins at https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/

Federal Match for Medicaid

Federal Medical Assistance Percentage (FMAP)
The federal government shares the cost of Medicaid with states. The federal share, or match, is determined by a formula in which the key variable is personal income. The Kaiser Family Foundation website defaults to the FY 2021 FMAP. Use the drop down box under TIMEFRAME to select FY 2020 FMAP.
Data in this section broadly characterize child health services in each state in terms of capacity and utilization. Use these data to understand the immediate context for services to CYSHCN in each state.

Health Care

Number of pediatricians per 1,000 children
Child population estimates based on children ages 0 through 18. Physician numbers represent ABMS Member Board certified physicians with an active Pediatric specialty recorded in the ABMS database as of June 30, 2020. Physicians may hold certification in more than one specialty.  These numbers include certificate holders who are retired and excludes physicians who are deceased. The United States total number of physicians with a family medicine specialty includes those practicing in American Samoa, Guam, Northern Mariana Islands, Palau, Puerto Rico, and the Virgin Islands, as well as those with overseas Army Post Office/Fleet Post Office military addresses.
Number of family practitioners
Physician numbers represent ABMS Member Board certified physicians with an active family medicine specialty recorded in the ABMS database as of June 30, 2020. Physicians may hold certification in more than one specialty. These numbers include certificate holders who are retired and excludes physicians who are deceased. The United States total number of physicians with a family medicine specialty includes those practicing in American Samoa, Guam, Northern Mariana Islands, Palau, Puerto Rico, and the Virgin Islands, as well as those with overseas Army Post Office/Fleet Post Office military addresses.
Number of child and adolescent psychiatrists per 1,000 children
Physician numbers represent ABMS Member Board certified physicians with an active child and adolescent psychiatric specialty recorded in the ABMS database as of June 30, 2020. Physicians may hold certification in more than one specialty.  These numbers include certificate holders who are retired and excludes physicians who are deceased. The United States total number of physicians with a family medicine specialty includes those practicing in American Samoa, Guam, Northern Mariana Islands, Palau, Puerto Rico, and the Virgin Islands, as well as those with overseas Army Post Office/Fleet Post Office military addresses.

Early Intervention Eligibility

Eligibility for Early Intervention services includes infants and toddlers “at risk” of developmental delay
Within federal guidelines, states have broad discretion in setting Early Intervention eligibility.

Mental Health

Percentage of non-CSHCN ages 3-17 that received any treatment or counseling from a mental health professional in the past 12 months
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about the coverage and financing of Behavioral Health at http://cahpp.org/project/the-catalyst-center/financing-strategy/behavioral-health/ .
Percentage of CSHCN ages 3-17 that received any treatment or counseling from a mental health professional in the past 12 months
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Percentage of children with emotional, behavioral or developmental problems for which treatment or counseling is needed who had adequate and continuous private and/or public insurance to pay for the services they need, in the past 12 months
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
This indicator reflects coverage and access to all needed care for children with emotional, behavioral, or developmental issues. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Percentage of non-CSHCN, ages 3-17, whose health insurance offers benefits or covers services that meet mental or behavioral health needs
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Private insurance plans are required by law to cover mental health services on par with physical health services. Medicaid is required to cover mental health services for enrollees under the age of 21 under the EPSDT benefit. However, not every mental or behavioral health service a child might require is covered, even if it is a plan benefit. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Percentage of CSHCN, ages 3-17, whose health insurance offers benefits or covers services that meet mental or behavioral health needs
Caution! Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Private insurance plans are required by law to cover mental health services on par with physical health services. Medicaid is required to cover mental health services for enrollees under the age of 21 under the EPSDT benefit. However, not every mental or behavioral health service a child might require is covered, even if it is a plan benefit. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/

Oral Health

Percentage of CSHCN receiving preventive dental care in the past year
Percentage of CSHCN with teeth in excellent or very good condition

Vision Testing

Percentage of children who had their vision tested at the following locations
Caution! Testing location responses are not mutually exclusive, because children may have had their vision tested at multiple locations, therefore percentages may add up to more than 100%.

Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.

This chart, which presents vision testing location, was created by Catalyst Center staff using data from the following National Survey of Children’s Health data queries:

Received vision screening at eye doctor or specialist office: https://www.childhealthdata.org/browse/survey/results?q=7743&r=1

Received vision screening at pediatrician or general doctor’s office: https://www.childhealthdata.org/browse/survey/results?q=7744&r=1

Received vision screening at school: https://www.childhealthdata.org/browse/survey/results?q=7746&r=1
Percentage of CSHCN who had their vision tested at the following locations
Caution! Testing location responses are not mutually exclusive, because children may have had their vision tested at multiple locations, therefore percentages may add up to more than 100%.

Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.

This chart, which presents vision testing location, was created by Catalyst Center staff using data from the following National Survey of Children’s Health data queries:

Received vision screening at eye doctor or specialist office: https://www.childhealthdata.org/browse/survey/results?q=7743&r=1&g=807

Received vision screening at pediatrician or general doctor’s office: https://www.childhealthdata.org/browse/survey/results?q=7744&r=1&g=807

Received vision screening at school: https://www.childhealthdata.org/browse/survey/results?q=7746&r=1&g=807

Foster Care

Number of children in foster care
Learn more about coverage and financing for CSHCN in foster care at https://ciswh.org/project/the-catalyst-center/financing-strategy/foster-care/
Percentage of children in foster care
Learn more about coverage and financing for CSHCN in foster care at https://ciswh.org/project/the-catalyst-center/financing-strategy/foster-care/
Health insurance coverage is the key to ongoing access to health care in the US. It is strongly associated with the likelihood that a child will receive basic primary and preventive care, that health problems will be identified and treated early and continuously and that a child with special health care needs will have a medical home that assures and coordinates access to specialty care and community resources. In general, the data elements presented here can form the foundation for any discussion of children’s health care financing and for financing of care for CYSHCN in a state.

Uninsured

Caution! For certain states, estimates are based on sample sizes too small to meet standards for reliability or precision. Please check the original data source to confirm whether this applies to the state data you are interested in.
Percentage of children without health insurance at some point in the past year
The percent of all children without coverage at any point in the year may be the most important indicator we have of social investment in child health. Across states, this figure captures differences in parental employment status and associated private coverage levels, as well as state funding for public coverage of children through Medicaid and CHIP.
Percentage of CSHCN without health insurance at some point in the past year
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of CHIP at https://ciswh.org/project/the-catalyst-center/financing-strategy/chip/
Percentage of children without health insurance at some point in the past year, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.

Underinsured

Caution! Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.
Percentage of children with inadequate health care coverage
According to The National Survey of Children's Health methodology adequate insurance is measured by the following criteria: child currently has health insurance coverage AND benefits usually or always meet child's needs AND usually or always allow child to see needed providers AND either no out-of-pocket expenses or out-of-pocket expenses are usually or always reasonable. If a child has inadequate insurance, their insurance did not meet all four of the criteria above.
Percentage of CSHCN with inadequate health care coverage
Caution! Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.
According to The National Survey of Children's Health methodology adequate insurance is measured by the following criteria: child currently has health insurance coverage AND benefits usually or always meet child's needs AND usually or always allow child to see needed providers AND either no out-of-pocket expenses or out-of-pocket expenses are usually or always reasonable. If a child has inadequate insurance, thier insurance did not meet all four of the criteria above.

Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.

Learn more about the coverage and financing of Medicaid Buy-Ins at https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/
Percentage of children with inadequate health care coverage, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.

Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.

Private Insurance Coverage

Percentage of children with private health insurance coverage only
Percentage of CSHCN with private health insurance coverage only
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of children with private health insurance coverage only, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.

Public Coverage: Medicaid, CHIP and SSI

Number of children ever enrolled in Medicaid annually
Caution! Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in Medicaid and CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Percentage of children enrolled in Medicaid
Caution! Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in Medicaid and CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Percentage of children enrolled in Medicaid or CHIP only
Percentage of CSHCN enrolled in Medicaid or CHIP only
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of children enrolled in Medicaid or CHIP only, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Medicaid to Foster Youth from other states
Under the Affordable Care Act (ACA), all states must provide Medicaid coverage to youth up to age 26 who were in foster care in the state as of their 18th birthday and enrolled in Medicaid. This column indicates whether the state also provides Medicaid coverage through a waiver to former foster youth up to age 26 who were enrolled in Medicaid in another state as of their 18th birthday.

Learn more about coverage and financing of care for children in foster care at https://ciswh.org/project/the-catalyst-center/financing-strategy/foster-care/
Maximum allowed income for CHIP eligibility as a percentage of the FPL
Caution! MAGI Adjusted
Number of children ever Enrolled in CHIP Annually
Caution! Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Percentage of children enrolled in CHIP
Caution! Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Distribution of Supplemental Security Income (SSI) Beneficiaries by Age
Caution! Children under age 18
TEFRA Medicaid state plan option/Katie Beckett waiver for children
The TEFRA state plan option allows states to enroll CYSHCN who require the equivalent of an institutional level of care (pediatric nursing home, hospital, intermediate care facility for persons with intellectual disabilities) in Medicaid even if family income exceeds Medicaid limits. TEFRA programs are sometimes called Katie Becket waivers. These waivers also deemed parental income and served a similar population of children with the same intention of providing home and community-based services rather than institutional placement but historically preceded the TEFRA state plan option.

Learn more about the coverage and financing of TEFRA at http://cahpp.org/project/the-catalyst-center/financing-strategy/tefra/
Premium Assistance Programs
In premium assistance programs, a state agency pays all or part of the premiums for an eligible family who has access to private health insurance coverage. Learn more at https://ciswh.org/project/the-catalyst-center/financing-strategy/premium-assistance/

Dual Public and Private Coverage

Percentage of CSHCN with a combination of public and private health insurance
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Dual coverage is an option in states which permit privately insured families to enroll their children in Medicaid in order to receive supplemental coverage, sometimes known as "wrap-around" coverage. This type of secondary Medicaid enrollment may be offered free or through the payment of premiums based on a sliding scale. Dual coverage helps address underinsurance, which is a significant problem for many privately insured CYSHCN whose coverage is too limited to meet their health needs.
Percentage of children with a combination of public and private health insurance, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. CSHCN with more complex health needs are defined as having functional limitations (alone or in combination with other qualifying needs), above-routine use of services or use of specialized services (no other qualifying needs on CSHCN Screener), or using prescription medication AND above-routine use of services.

Health Care Reform

Marketplace overview
Caution! The term Health Insurance “Exchange” is also used interchangeably with Health Insurance “Marketplace.”

Financing

Total Title V Block Grant Expenditures, FY 2019
For a fuller picture of the source and amount of both state and local funds that contribute to the Title V block grant partnership view https://mchb.tvisdata.hrsa.gov/ . Learn more about the coverage and financing of family supports at https://ciswh.org/project/the-catalyst-center/financing-strategy/family-supports/
Percentage of Title V Block Grant Budget From State, Federal, and Local Funding Sources
States receive federal funds for Title V activities which they must match at the rate of 75 cents for each federal dollar, however, in many states there are additional sources of funding. For a fuller picture of the source and amount of both state and local funds that contribute to the Title V block grant partnership view https://mchb.tvisdata.hrsa.gov/ Learn more about the coverage and financing of family supports at https://ciswh.org/project/the-catalyst-center/financing-strategy/family-supports/

National Performance Measures Chosen by State

Fifteen National Performance Measures (NPMs) across five population health domains were established for the Title V MCH Services Block Grant program. Based on its identified priority needs, States and territories select a minimum of five NPMs for programmatic focus. For each of these selected NPMs, States develop at least one related Evidence-based or –informed Strategy Measures (ESMs) to assess and demonstrate the impact of its State Title V strategies on the NPM.

The total number of states who selected each NPM above reflects the 50 states, the District of Columbia, and Puerto Rico; it does not include other territories that may have selected these NPMs.

To learn more about the NPMs, go to https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/NationalPerformanceMeasures

Federal MCHB Core Outcomes for CSHCN

Percentage of families raising CSHCN who received family-centered care during the past 12 months
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of families raising CSHCN who received family-centered care during the past 12 months, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Percentage of families raising CSHCN who report their child's doctors or other health care providers are sensitive to the family's values and customs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Percentage of CSHCN who receive coordinated, ongoing, comprehensive care within a medical home
Corresponds with the MCHB Block Grant Performance Measure: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home. Learn more about the coverage and financing of care coordination at https://ciswh.org/project/the-catalyst-center/financing-strategy/care-coordination/
Percentage of children who receive coordinated, ongoing, comprehensive care within a medical home, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home.

Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Percentage of CSHCN whose families have continuous and adequate private and/or public insurance to pay for the services they need
Corresponds with the MCHB Block Grant Performance Measure: The percent of children, ages 0 to 17 who are continuously and adequately insured. Adequacy of insurance is measured using three items: Health insurance benefits met child's needs, coverage allowed child to see needed provider, and reasonable out-of-pocket health care expenses.
Percentage of children, ages 0 through 17, who are continuously and adequately insured, by complexity of health care needs
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: The percent of children, ages 0 to 17 who are continuously and adequately insured.

Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Percentage of youth with special health care needs who receive the services necessary to make appropriate transitions to adult health care, work, and independence -- CSHCN ages 12-17 only
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care. Learn more about the coverage and financing of transition services at http://cahpp.org/project/the-catalyst-center/financing-strategy/transition-services/
Percentage of youth with special health care needs, whose caregiver knows how to keep or obtain health insurance coverage as the youth transitions into adulthood, CSHCN ages 12-17 only
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of transition services at http://cahpp.org/project/the-catalyst-center/financing-strategy/transition-services/ .
Percentage of youth whose caregiver knows how to keep or obtain health insurance coverage as the youth transitions into adulthood, by complexity of health care needs -- ages 12-17 only
Caution! Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of transition services at https://ciswh.org/project/the-catalyst-center/financing-strategy/transition-services/.

Approved Medicaid Emergency Authorities

Approved 1135 Waiver Provisions
Caution! Data accurate as of March 5, 2021. 1135 Waiver authorities are available during any public health emergency (PHE). The provisions presented here were approved through authorities available during the COVID-19 PHE. Additional waiver authorities approved during the COVID-19 PHE can be seen here. For more information on emergency waiver authorities during the COVID-19 PHE and their impact on CYSHCN, please see these Catalyst Center fact sheets .
Approved Section 1915c Waiver Appendix K Provisions
Caution! Data accurate as of March 5, 2021. Section 1915c Appendix K Waiver authorities are available during any public health emergency (PHE). The provisions presented here were approved through authorities available during the COVID-19 PHE. Additional waiver authorities approved during the COVID-19 PHE, can be seen here. For more information on emergency waiver authorities during the COVID-19 PHE and their impact on CYSHCN, please see these Catalyst Center fact sheets.

This project (U1TMC31757) is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $500,000, with no financing by nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government; HRSA Project Officer Sarah Beth McLellan.