Disclosures: Elizabeth Martin, MD, MPH, MHS: No financial relationships or conflicts of interest

Objective: To evaluate whether children receive recommended inpatient rehabilitation services in states with different Medicaid expansion programs, or without contracted rehabilitation facilities

Design: Retrospective Cohort Study Setting : Academic Medical Center Children’s Hospital Participants : Pediatric patients ages 0-18 treated between 2017-2019 with formal recommendations for ongoing inpatient rehabilitation needs, and Tennessee or Kentucky Medicaid insurance.

Interventions: Interventions : Not Applicable

Main Outcome Measures: Disposition after acute hospital stay

Results: Among 130 patients ages 0-18, 25 patients (19%) had Kentucky Medicaid, and 105 (81%) had a form of Tennessee Medicaid. Tennessee Medicaid plans included Tenncare Select, Blue Care, Tenncare United Community Plan, Tenncare Amerigroup Community Plan, United Community Plan, and Children’s Special Services. 60/105 (57%) children discharged home with Tennessee Medicaid when recommended to have inpatient rehab services as opposed to 7/25 (28%) of children with Kentucky Medicaid. Type of Tennessee Medicaid was associated with disposition, with Tenncare United Community Plan most likely to discharge home rather than IRF (p=0.001). Reasons for children with Kentucky Medicaid discharging home included need for ongoing acute medical management or oncology care in Tennessee. Reasons for children with Tennessee Medicaid discharging home included prolonged admission and progression of function, denied by insurance, prolonged stay due to single case agreement and progression of function, need for acute oncology, neurosurgery or cardiac care in state. Conclusions: Our prior work has shown that in a state without a pediatric IRF, pediatric patients with private insurance are more likely to receive recommended services than those with state Medicaid insurance. Additional coordination is required to provide inpatient rehabilitation out of state, including individual contracts with insurance providers. This can result in prolonged acute hospital stays and children not receiving recommended rehabilitation services. Our data demonstrates the differences in care provided for families with medicaid who reside in a state with a state-contracted pediatric inpatient rehabilitation facility, and a neighboring state without.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/state-medicaid-and-access-to-pediatric-inpatient-rehabilitation-services-a-comparison-of-two-states/