A recent Children’ Hospital Association study reported that 2 of 3 children who were medically complex were enrolled in Medicaid. A recent article in Pediatrics reported that in North Carolina medically complex children, although numbering only 5% of enrollment represented over 50% of the cost for the pediatric Medicaid population. The standards utilized by the Children’s Hospital Association to define the medically complex child were based on CRG groups 5b-9. The report noted that the this group of patients receive the majority of their care at a tertiary children’s hospitals.
As a caregiver of two complex children and an activist who interacts with numerous others who give care to the medically complex those observations reflect our universal reality. That being the case I would hope that somehow we could influence the management of these tertiary care centers to provide practice models that are suitable to children with complex medical needs.