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Abstract: This study examines whether the US public health insurance program Medicaid suppresses racial disparities in parental identification of service needs of their children with special health care needs (CSHCN). We analyze data from the 2001 US National Survey of CSHCN (n = 14,167 children). We examine three outcomes which were parental identification of (a) the child''s need for professional care coordination, (b) the child''s need for mental health services, and (c) the family''s need for mental health services. A suppression analysis, which is a form of mediation analysis, was conducted. Our results show a disparity, reflected in a negative direct effect of race for all three outcomes: Black parents of CSHCN are less likely to report a need for services than White parents of CSHCN and Medicaid coverage was associated with reduced racial disparities in reporting the need for services. These analyses suggest receipt of Medicaid is associated with a suppression of racial disparities in reported need for services. [Copyright &y& Elsevier]

Abstract: Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household’s absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005–06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child’s care and whether the parent stopped working due to the child’s health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child’s health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child’s impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden. [Copyright &y& Elsevier]