Medicaid Reimbursement of Pediatric Surgeries

Abstract

Intro: Medicaid is an important means of health care insurance for millions of people in the United States and 49.5% of Medicaid patients are children. . Reimbursements in Medicaid have been shown to be a limiting factor in access to health care in pediatric patients. This study investigates the amount of difference in reimbursement between Medicaid and Medicare, as well as state to state variability.

Methods: Medicaid and Medicare fee reimbursements were collected from each state for 10 different common pediatric orthopedic procedures. The difference between and variability of reimbursement were calculated for both Medicaid and Medicare.

Results: There was an average difference of -22.2% ± 26.9 or -$184.14 ± $226.89 in Medicaid reimbursement compared to Medicare. New Jersey had the greatest difference at 72.7% less reimbursement with Medicaid, while Delaware had higher Medicaid reimbursement of 95.2% compared to Medicare. Only three states had higher reimbursement with Medicaid compared to Medicare for all 10 procedures. Additionally, there was statistically higher coefficient of variation with Medicaid reimbursement compared to Medicare (0.26 vs 0.46) among states.

Conclusion: Medicaid reimbursement is significantly lower compared to Medicare for several common pediatric orthopedic procedures across the United States. The lower Medicaid reimbursement fees may contribute as a barrier to care access for an at-risk population of children.