Families are often required to pay for health care services not covered or inadequately covered by their insurance plans. These services may include therapies, home health care, prescription drugs, mental health care, medical equipment, and dental services. Families of over half of CSHCN reported spending $250 or more on health care in the previous year for the care of their child with special health care needs. The families of 11.8 percent of CSHCN spent between $501 and $1,000, and the families of 22.1 percent of children spent more than $1,000.

Children in low-income families are less likely to have high levels of expenditures than are children from families with higher incomes. This could be because children in low-income families are more likely to be covered by Medicaid and SCHIP, which limit the co-pays charged to families. In addition, these data only include the expenses that families actually paid; low-income families may be more likely to have unpaid bills that are not reported here. Alternatively, low-income families may be more likely to delay or forgo care if they feel they cannot afford the out-of-pocket costs.

The families of non-Hispanic White children are the most likely to pay more than $1000 in health care expenses; 27.7 percent did so, compared to the families of 15.6 percent of Hispanic children and 9.1 percent of non-Hispanic Black children. Non-Hispanic White children are also the least likely to have families that pay less than $250 per year. This may be related to the insurance status of non-Hispanic White children.

The level of out-of-pocket costs borne by families of CSHCN also varies by their children’s insurance status. Thirty percent of uninsured children’s families pay more than $1000 annually, compared to 32.3 percent of those with private coverage and 6.2 percent of those with public insurance. Similarly, 76.0 percent of children with public coverage live in families that pay less than $250 per year out of pocket for their child’s health care, compared to 22.7 percent of those with private insurance and 32.8 percent of uninsured children. This may be due to the limits on copayments within public insurance programs, or because publicly-insured and uninsured families are not able to pay bills they receive.

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