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Background: Obesity rates continue to rise among children, but knowledge regarding spending patterns of Medicaid enrollees with documented obesity are lacking.

Objective: We aimed to describe Medicaid expenditure patterns and determine the degree to which specific clinical characteristics and conditions contribute to high expenditures among children with obesity.

Design/Methods: We performed a retrospective cross-sectional analysis of children aged 2-17 years with a diagnosis code (ICD-10) for obesity continuously enrolled in the nationally-representative 2017 Medicaid Marketscan database. Expenditures were measured as median per member per year (PMPY) spending and categorized based on prior literature from low to high PMPY expenditure groups: <80th%, 80-<95th%, 95-<99th%, and ≥99th%. Inpatient, outpatient, and pharmacy expenditures were analyzed. Covariates included demographic factors, common obesity co-morbid conditions (e.g., hypertension), number of complex chronic conditions (CCCs), and number of mental health conditions. Chi square tests were used to compare PMPY spending across expenditure groups and logistic regression analyses were used to measure demographic and clinical characteristics associations for patients in the high spending groups (≥95th%).

Results: We identified 300,286 children with a diagnosis of obesity. Children aged 12-17 years, of non-Hispanic white race/ethnicity, with obesity comorbid conditions, at least 1 CCC, or mental health condition were most likely to be in the highest spending group. (Table 1). The highest overall median PMPY spending was from inpatient and outpatient therapy and treatment ($6,018 and $800, respectively). Mental health therapy and treatment drove the PMPY spending in the higher spending groups (≥99th% group $16,471) (Table 2). Characteristics found to be associated with being in the higher spending groups included: age 12-17 years, having an obesity comorbid condition, having ≥ 1 CCC and mental health condition, with these associations increasing considerably as the number of CCCs or mental health conditions increased (Table 3).

Conclusion(s): Inpatient and outpatient mental health expenditures made up a large proportion of spending among Medicaid-enrolled children with obesity. Important drivers of cost in this population included having obesity comorbid conditions and mental health conditions. Future research is needed to determine if some of these costs are avoidable in children with obesity.

Presented at the 2021 PAS Virtual Conference

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Presented at the 2021 PAS Virtual Conference

Medicaid Expenditures Among Children with Documented Obesity

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Pediatrics Commons