HIGH-EXPENDITURE CHILDREN WITH SUPPLEMENTAL SECURITY INCOME

Objective. To examine the clinical characteristics and health service use of children with high Medicaid expenditures. Methodology. We exami ned 1992 Medicaid claims and eligibility files from four states (Calif ornia, Georgia, Michigan, Tennessee) for children with at least $10 00 0 billed to Medicaid who obtained Medicaid through the Supplemental Se curity Income (SSI) Program and a comparison group (matched by age gro up and gender) of children receiving Medicaid for other reasons. We co mpared mean expenditures, examined expenses by category, and examined diagnoses associated with at least $10 000 in expenses. Results. In 19 92, Medicaid paid on average similar to$1000 for children with non-SSI Medicaid enrollment. Expenditures for children with SSI were 2.9 to 9 .4 times higher, but once the similar to 10% of children with high exp enditures were excluded, SSI average expenditures were only 1.5 to 2.7 times higher than the non-SSI average. Children with high expenditure s are likely to use hospitals and longterm care, and these services ac count for more than half of the average expenditures. Children with hi gh expenditures and SSI are more likely to have chronic medical condit ions than are their peers enrolled in Medicaid but not through SSI. Co nclusions. A small proportion of children, even on SSI, account for ve ry large proportions of Medicaid expenditures. Most children with SSI, despite having relatively severe mental health, physical, or developm ental disabilities, have relatively modest Medicaid expenditures.