Well-Child Care in Infancy and Emergency Department Use by South Carolina Medicaid Children Birth to 6 Years Old

Objectives: This analysis tests the hypothesis that children enrolled in Medicaid with the recommended early and periodic screening, diagnosis and treatment (EPSDT) visits in the first 24 months utilize fewer emergency department (ED) services birth to 6 years old than children with fewer visits. Methods: Data represent all health encounters for a 3-year birth cohort of South Carolina children continuously enrolled in Medicaid from birth to 6 years old (n = 18,512). The association between receiving the American Academy of Pediatrics recommended EPSDT visits and other health service utilization is examined. Results: Children with the recommended EPSDT visits had a greater adjusted rate of sick-child visits with a primary care provider (rate ratio, 1.62; 95% CI 1.50-1.76) and a lower adjusted rate of ED visits for ambulatory care-sensitive conditions (rate ratio, 0.88; 95% CI, 0.81-0.95). Conclusion: Recommended EPSDT use in infancy may be associated with a shift in health care from the ED to the office setting by children enrolled in Medicaid in the first six years of life.