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Primary Submission Category: Infants/children/youth
Medicaid Generosity and State Variation in Developmental Screening and Surveillance
Authors: Torrey Robinson, Kerri Ivey, Benjamin Walker,
Presenting Author: Torrey Robinson*
Introduction
State-level variation in developmental monitoring, including screening and surveillance, is not fully explained by child or family characteristics. Nearly half of U.S. children are covered by Medicaid, yet state Medicaid policies vary in eligibility thresholds, provider reimbursement, and covered services beyond expansion status alone. Less is known about whether differences in overall Medicaid generosity are associated with early childhood developmental screening prevalence.
Methods
Using nationally representative data from the 2018–2019 National Survey of Children’s Health, we estimated two-level multilevel logistic regression models with individuals nested within states. State Medicaid generosity was operationalized using the Medicaid Generosity Index and modeled per 10-point increase. Guided by Andersen’s Behavioral Model, models were adjusted for child, family, and healthcare access characteristics.
Results
Among children aged 9–35 months, 38.0% received developmental screening. Screening was more common when providers asked about parental concerns (64.1% vs 23.4%, p < 0.001). Variance components models indicated that 3% of variance in developmental screening and 1% in surveillance were attributable to between-state differences. After adjusting for covariates, state-level Medicaid generosity was associated with increased odds of developmental screening (OR 1.11; 95% CI 1.01–1.23) but not surveillance (OR 1.04; 95% CI 0.96 – 1.12).
Conclusions
Greater state-level Medicaid generosity is associated with increased developmental screening, independent of child and family characteristics. These findings demonstrate that state policy environments may contribute to variation in developmental screening, while surveillance may operate through a different pathway.