We examined children's Medicaid participation during 2019-21 and found that as of March 2021, states newly adopting continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation compared to states with previous continuous eligibility policies.

OBJECTIVES: In the United States, caregivers of children and youth with special healthcare needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating care and forgone medical care.

METHODS: This cross-sectional study used data from the 2018-2020 National Survey of Children's Health, which included 102,740 children across all 50 states. We described time spent coordinating care for children with less complex SHCN (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). We examined race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN and used multivariable logistic regression to examine the association between time spent coordinating care and forgone medical care.

RESULTS: Over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent >5 hours/week on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was associated with an increasing probability of forgone medical care: 6.7% for children whose caregivers who spent no weekly time coordinating care versus 9.4% for <1 hour; 11.4% for 1-4 hours; and 15.8% for >5 hours.

CONCLUSION: Reducing time spent coordinating care and providing additional supports to low-income and minoritized caregivers may be beneficial for pediatric payers, policymakers, and health systems aiming to promote equitable access to health care for CYSHCN.

Importance: The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments.

Objective: To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children.

Design, Setting, and Participants: This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households.

Exposures: Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021.

Main Outcomes and Measures: Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days.

Results: Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y.

Conclusions and Relevance: In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.

Importance: The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments.

Objective: To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children.

Design, Setting, and Participants: This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households.

Exposures: Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021.

Main Outcomes and Measures: Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days.

Results: Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y.

Conclusions and Relevance: In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.

OBJECTIVE: To assess the relationship between posthospitalization prescription fills for recommended asthma discharge medication classes and subsequent hospital readmission.

STUDY DESIGN: This was a retrospective cohort analysis of Medicaid Analytic Extract files from 12 geographically diverse states from 2005-2007. We linked inpatient hospitalization, outpatient, and prescription claims records for children ages 2-18 years with an index hospitalization for asthma to identify those who filled a short-acting beta agonist, oral corticosteroid, or inhaled corticosteroid within 3 days of discharge. We used a multivariable extended Cox model to investigate the association of recommended medication fills and hospital readmission within 90 days.

RESULTS: Of 31,658 children hospitalized, 55% filled a beta agonist prescription, 57% an oral steroid, and 37% an inhaled steroid. Readmission occurred for 1.3% of patients by 14 days and 6.3% by 90 days. Adjusting for patient and billing provider factors, beta agonist (hazard ratio [HR] 0.67, 95% CI 0.51, 0.87) and inhaled steroid (HR 0.59, 95% CI 0.42, 0.85) fill were associated with a reduction in readmission at 14 days. Between 15 and 90 days, inhaled steroid fill was associated with decreased readmission (HR 0.87, 95% CI 0.77, 0.98). Patients who filled all 3 medications had the lowest readmission hazard within both intervals.

CONCLUSIONS: Filling of beta agonists and inhaled steroids was associated with diminished hazard of early readmission. For inhaled steroids, this effect persisted up to 90 days. Efforts to improve discharge care for asthma should include enhancing recommended discharge medication fill rates.

<p>Vegetation may influence asthma exacerbation through effects on aeroallergens, localized climates, air pollution, or children's behaviors and stress levels. We investigated the association between residential vegetation and asthma exacerbation by conducting a matched case-control study based on electronic health records of asthma patients, from the Children's Hospital of Philadelphia (CHOP). Our study included 17,639 exacerbation case events and 34,681 controls selected from non-exacerbation clinical visits for asthma, matched to cases by age, sex, race/ethnicity, public payment source, and residential proximity to the CHOP main campus ED and hospital. Overall greenness, tree canopy, grass/shrub cover, and impervious surface were assessed near children's homes (250&nbsp;m) using satellite imagery and high-resolution landcover data. We used generalized estimating equations to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between each vegetation/landcover measure and asthma exacerbation, with adjustment for seasonal and sociodemographic factors-for all cases, and for cases defined by diagnosis setting and exacerbation frequency. Lower odds of asthma exacerbation were observed in association with greater levels of tree canopy near the home, but only for children who experienced multiple exacerbations in a year (OR = 0.94 per 10.2% greater tree canopy coverage, 95% CI = 0.90-0.99). Our findings suggest possible protection for asthma patients from tree canopy, but differing results by case frequency suggest that potential benefits may be specific to certain subpopulations of asthmatic children.</p>