Centers for Medicare and Medicaid Services (CMS) Supported Interventions to Address Health Disparities in Pediatric Populations: A Scoping Review

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Myers, Meera Rao, Sebastian Densley, Rishiraj Bandi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4095298/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE: To assess the scope of Centers for Medicaid and Medicare (CMS) and CHIP funded interventions to minimize pediatric health disparities. METHODS: The authors searched Cochrane Library, Embase, PubMed, and Web of Science using keywords and terms related to Medicaid, Medicare, CMS, public health insurance, pediatric, and health disparities. Full-text, peer-reviewed studies published in English between 2013-2023 focusing on pediatric patients with interventions to reduce health disparities funded by CMS were included. The review of the literature databases was completed over one month, ending in June 2023. Articles were screened for eligibility by the primary author and senior author. Co-authors carried out data tabulation and extraction. RESULTS: Four peer-reviewed, full-text studies published in English between 2013-2023 that focused on pediatric patients (0-18 years old) with public health insurance with interventions to reduce health disparities funded by CMS were included in the review. Study designs included one randomized control study, one intervention study, one cross-sectional study, and one policy statement. Patient sample sizes ranged from 129 to 36,000, including racial/ethnic minorities, low-income families, Medicaid-insured children and adolescents, and Children’s Health Insurance Program recipients. CONCLUSION: Few studies exist examining CMS-funded interventions to minimize pediatric health disparities. Federal-funded programs, specifically CMS, can dismantle health inequities by addressing SDoH impacting minoritized and marginalized pediatric patients. CHIP Medicare CMS public insurance pediatric health disparities health inequities Figures Figure 1 Introduction Healthcare disparities are pervasive in marginalized and minoritized pediatric populations and lead to subsequent unjust differences in pediatric health outcomes. 1 The recent prioritization of the delivery of and access to equitable pediatric healthcare 2 , 3 has forced the examination of Center for Medicare and Medicaid Services’ (CMS) role in reducing pediatric healthcare disparities. Social determinants of health (SDoH), “ the conditions in the environment where people are born, live, play, work, learn, worship and age that affects a wide range of health, outcomes, and risks,” mediate health disparities. SDoH are drivers of disparities classified into five domains: healthcare access and quality, neighborhood and built environment, social and community context, education access and quality, and economic stability 1 , all affecting the life-course trajectory of pediatric patients. 4 Those pediatric patients disadvantaged by racism and discrimination, socioeconomic status, geography, and environment all suffer poor health and health outcomes. Poverty, affecting over 10 million children in the United States (US), limits a child’s access to healthcare and other positive SDoH, such as nutritious meals, education, violence-free neighborhoods, and healthcare services. 5 Marginalized, minoritized, and disenfranchised pediatric populations, including children of immigrants, those in foster care/houseless, those with disabilities, and those identifying as racial/ethnic and religious minorities, are the most likely to live below poverty and suffer persistent healthcare disparities. 5 Black, Hispanic, and Native American pediatric patients are more likely than their white counterparts to have poor health status and health outcomes. 6 – 8 Governed by the societal distribution of power, money, and resources, racism and embedded poverty are foundational to the SDoH schema and pediatric healthcare disparities. Recognizing the role of SDoH on pediatric health, CMS has committed to improving pediatric health outcomes by minimizing disparities and controlling healthcare costs. 9 This commitment has resulted in various delivery approaches, benefits, and reimbursement methodologies to improve state-level pediatric health outcomes. CMS additionally encourages individual states to evaluate interventions and initiatives to address SDoH, explicitly focusing on housing-related services and supports, non-medical transportation, home-delivered meals, educational services, employment, community integration and social support, and case management. 9 Despite a robust body of research demonstrating the role of SDoH on pediatric health and subsequent health disparities, few efforts have been made to translate such research into interventions aimed at pediatric health disparity reduction. 10 This scoping review identified CMS’ role in reducing pediatric health disparities through evidence-based interventions. The evidence from this scoping review may guide and inform future CMS-supported state-level policies and initiatives to reduce healthcare disparities in pediatric populations. Methods The review team consisted of a group of researchers with medical and public health backgrounds who were selected based on their knowledge of federally funded health insurance's role in care delivery to pediatric patients in the United States. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) was used as a reference checklist in the development of the study sections. 11 York methodology, and the updated criteria provided by the Joanna Briggs Institue were utilized as a framework to guide the review. 11 Eligibility Criteria: We included peer-reviewed, full-text studies published in English between 2013 and 2023 focused on pediatric patients < 18 years old highlighting disparity-reduction sponsored by CMS, including the Children’s Health Insurance Program (CHIP). Studies were excluded if the text was outside the period, not peer-reviewed, published in a language other than English, failed to include the target population, or disparity-reduction interventions funded by different mechanisms. Descriptive and observational studies (including narrative, systematic, and qualitative reviews) were excluded. Four electronic databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to identify peer-reviewed articles from primary sources, secondary data sources, and case studies. The review of the literature was completed over one month, ending in June 2023. Articles were screened for eligibility by the primary author (CM) and senior author (LS). Data tabulation and extraction were carried out by co-authors (MR, SD, RB, and DD). Search strategy Keywords and MeSH terms were developed with a research librarian experienced with scoping review protocols. Search terms focused on Medicaid, Medicare, CMS, CHIP, public health insurance, pediatric, juvenile, adolescent, pediatric patients, newborn, infant, neonate, health disparities, health inequality and inequity. Three benchmark articles were selected to validate the search for their focus on discrepancies between pediatric healthcare and public US insurance. Selection of Sources of Evidence All co-authors (MR, SD, RB, and DD) extracted and summarized the data from relevant studies. The primary author (CM) and senior author (LS) reviewed all tabulated data to resolve any possible discrepancies. Summary tables consisted of one evidence table (Table 1 ) describing the characteristics of the study, including contextual factors and intervention outcomes. The lessons learned from the thematic analysis (Table 2 ) were also included. Thematic analysis was carried out to identify similar themes and patterns in future directions across studies. Table 1 Summary of Evidence for CMS-supported interventions to minimize pediatric health disparities Primary Author (Year) Study Design Sample Size Priority Population Study Purpose Setting Stakeholders Health Care Disparities Addressed Racine (2014) Policy Statement N/A Near-poor children in the United States 1. To review the features of CHIP, summarize the program's effects on coverage, access, health status, and disparities among participants 2. To identify challenges in the provision of health insurance for vulnerable populations 3. Recommendations on how to expand and strengthen national commitment to providing health insurance United States of America U.S. Federal Government; state-level government; policymakers; pediatricians; CHIP-eligible children Racial/ethnic minorities, Socioeconomic status, non-citizens/immigrants Kercsmar (2017) Intervention Study n = 36000 children and adolescents Children and Adolescents with Asthma in Hamiton County, Ohio To test the implementation of a hospital-driven improvement collaborative associated with a reduction in acute asthma health care utilization in a population of Medicaid-insured Cincinnati Children’s Hospital Medical Center Medicare and Insurance Companies, Healthcare institutions, patients, and families Racial/ethnic, Socioeconomic status Gottfredson (2018) Randomized Controlled Trial n = 129 families Juvenile Justice-Involved Youth To test the effects of a Functional Family Therapy (FFT) Program under contemporary natural conditions with at-risk children in urban minority populations that have a higher risk of gang involvement Single Courtroom in Philadelphia, PA Educational Institutions, Juvenile Justice and Child Welfare Systems, adjudicated youth, and families Racial/ethnic, Socioeconomic status, Neighborhood safety Kim (2023) Cross-Sectional Study n = 6458 children and adolescents Children and Adolescents from Disorganized Neighborhoods To test the effect of neighborhood disorganization on care engagement using a cohort of children with chronic conditions Chicago, IL Families and children from disorganized neighborhoods, local government, social Service providers, healthcare institutions Racial/ethnic, Socioeconomic status Table 2 Scoping Review Outcomes, Lessons Learned and Shared Themes Primary Author (Year) Outcomes/Lessons Learned Shared Themes Racine (2014) 1. State-by-state variability in cost sharing for CHIP stand-alone programs needs to be minimized to maintain true access to health care services, particularly pediatric subspecialty care. 2. Pediatricians and families must vigilantly assess the comprehensiveness of CHIP benefit packages. 3. Policymakers must set payment rates for pediatricians at adequate levels to maintain care for and engagement with CHIP enrollees. 4. Emancipated minors, children up to 26 years of age, foster youth, and children of undocumented immigrants should be monitored closely for eligibility and benefits. 1. Community engagement measures taken by policymakers and medical institutions profoundly impact healthcare standards for underserved communities. 2. Increasing patient education and awareness about CMS improves care access rates. 3. Race and place of residence impact patient care engagement and the effects of healthcare interventions. 4. Increased insurance coverage improves care access for pediatric patients Kercsmar (2017) 1. Medications in hand at discharge mitigated a major barrier for the urban, indigent families in the study. 2. Using a care coordinator to facilitate an evidence-based care bundle led to reduced acute care service use by the highest-risk patients. 3. Following the QI framework with which interventions were developed and tested allowed for real-world, sustainable improvements to occur. Gottfredson (2019) 1. FFT-G was effective in reducing recidivism measured in official records. 2. The beneficial effects of the treatment were most evident after the intense surveillance period ended, and the treatment cases had to exercise their new skills to keep out of trouble. 3. The finding of no effects on hypothesized FFT-G mediators suggests that future research on FFT and family therapy should further investigate the timing of effects as well as the mechanisms leading to effects. 4. Youth who receive FFT-G are less likely to receive alternative, costly, public services during the time they are receiving FFT-G Ross (2022) 1. Medicaid expansion has had generally positive effects on insurance coverage, in-hospital mortality, and access to rehabilitative care among young adult firearm trauma patients. 2. Medicaid expansion has had positive effects on insurance coverage and access to rehabilitative care. It has reduced some racial and socioeconomic disparities in these outcomes among young adult MVC trauma patients. 3. Future studies should evaluate Medicaid expansion's effects on firearm and MVC trauma patients' long-term health and functional, social, and economic outcomes. Data charting and collation, summarization, and reporting of results . Study characteristics were tabulated to include the study's primary author, study type, sample size, target population, and study topic area. Lessons learned based on thematic analysis to identify common themes for future directions and recommendations across studies (Table 2 ). Results The screening process is outlined in the PRISMA diagram (Fig. 1 ). The initial study extraction resulted in 1,577 articles from Pubmed (n = 10), Embase (n = 957), Web of Science (n = 537), and Cochrane (n = 73). Studies were excluded if they did not include Medicare or Medicaid-funded interventions to reduce healthcare disparities (n = 811), focused on adult populations (n = 355), or focused on maternal and child health rather than pediatric health outcomes (n = 32). Duplicate studies were deleted (n = 354). Twenty-five studies that met the inclusion criteria: Embase (n = 19), PubMed (n = 2), Web of Science (n = 4), and Cochrane (n = 0). An additional twenty-one studies were excluded following a full review; abstracts and not full text (n = 18), reported interventions funded by mechanisms other than CMS (n = 3). Consequently, a total of 4 studies were retained for analysis. The four included studies were published between 2013 and 2023. Study designs included a randomized control study (n = 1), intervention study (n = 1), cross-sectional study (n = 1), and policy statement (n = 1). Sample sizes ranged from 129 to 36,000, including low-income families, Medicaid-insured children and adolescents, and Children’s Health Insurance Program recipients (Table 1 ). Priority Populations & Key Stakeholders Priority pediatric populations targeted through CMS-funded interventions were juvenile justice-involved youth (n = 1), children and adolescents with asthma (n = 1), and children and adolescents from disorganized neighborhoods (n = 2) (Table 1 ). Key stakeholders essential for intervention implementation included healthcare institutions (n = 3), educational institutions (n = 1), national and local politicians, policymakers, governmental programs (n = 3), insurance companies (n = 3), functions in juvenile justice (n = 1), pediatricians and pediatrics-leaning medical students (n = 1), vulnerable and hospitalized children and young adults (n = 4), and families of pediatric patients (n = 4). The results of these studies provide evidence of the role of SDoH and healthcare disparities for uninsured, minority, and low socioeconomic status patient populations. Discussion We aimed to assess CMS-funded interventions targeting disparity reduction in the pediatric population. While pediatric health research has progressed beyond disparity detection, evidence-based implementation of targeted interventions remains lacking. 10 One obstacle of particular interest is that research translation can be inherently inequitable, as explained by the Fundamental Cause Theory of health disparities, 12 suggesting that equitable interventions for health disparities reduction require medico-social partnership, community engagement, and an intentional focus on minoritized and marginalized pediatric populations. 12 The CMS-funded interventions highlighted in this scoping review have provided evidence that novel systematic approaches addressing disparities in pediatric healthcare are feasible, focusing on the importance of equity in healthcare access, medico-social context, and the cost savings of disparity reduction. Equity in Healthcare Access Health insurance, a foundational element of equity in access to healthcare, facilitates entry into the healthcare system. While health insurance is the foundation, pillars of healthcare access include having a medical home, feasibility and ease of seeking care and treatments, and receiving timely care. 13 The Committee on Child Health 15 statement explained the impact of increasing insurance for pediatric populations within CMS and the CHIP program in closing the equity gap 14 . Historically, pediatric patients have experienced disparities in access to care based on race, ethnicity, socioeconomic status, geographic location, and disability status. Sweeping healthcare reform in 1965 led to the enactment of Medicaid and Medicare, aligning federal-state and individual-level interests to provide health coverage for pregnant women, low- and middle-income children, and other vulnerable populations. 15 The CMS program has undergone several reforms, including the Affordable Care Act in 2010, to improve healthcare access for all, despite state-state variability in insurance coverage and benefits. Increased health insurance coverage has improved access and quality of care, in-hospital mortality, and access to rehabilitative care for pediatric patients 16 , 17 . With telemedicine, Medicaid has recently targeted health disparity reduction in pediatric populations in rural or noncore geographic domains. 18 The need for increased coverage under public insurance, however, remains as children in rural communities face more barriers to care than their urban counterparts; recommendations include alternative forms of telemedicine and state-specific reductions of geographic restrictions. 18 Inequities in healthcare access are also apparent in children with autism spectrum disorder (ASD); increasing the Medicaid HCBS waiver generosity ameliorated the black-white disparity in unmet healthcare needs. 19 Meanwhile, state mandates for private insurance companies to provide services for children with ASD did not affect racial disparities, which could reflect the fact that children with ASD enrolled in Medicaid use more services than their privately insured counterparts. 19 , 20 For children with asthma, those insured by Medicaid frequently visited the emergency department for uncontrolled asthma, where they then could not afford to fill given prescriptions, demonstrating a need for increased coverage. 21 Importance of Medico-social Context Central to each paper, community engagement measures taken by policymakers and medical institutions demonstrated a profound impact on the healthcare standard for underserved communities. Addressing medical mistrust through highly trained community health workers and bundling health care through a care coordinator are two examples of community engagement strategies that ultimately resulted in improved health outcomes within their communities. Additionally, community engagement through tailored medical policies that meet the needs of community members, such as providing inhalers at discharge to overcome a community pharmacy access barrier, was vital to observed improvements. Gottfredson and colleagues 22 presented the importance of family and community-oriented interventions on lowering adolescent delinquency while minimizing costs for the judicial and political system. Kim 23 and colleagues' observational study analyzed the impact of neighborhood disorganization in local communities on a child’s trust and access to healthcare. The primary finding from this study highlights the possible interaction between neighborhood context and minority ethnicity backgrounds. Using similar hospital-driven implementation methods, Kercsmar 24 highlighted the treatment efficiency of medication-in-hand therapy and community screening guidelines for adolescent asthma intervention. With the improvement in healthcare utilization seen in such interventions, similar phased approaches are warranted for dealing with other common pediatric pathologies. Disparity Reduction and Cost Savings Health disparities financially burden the patients, families, and the healthcare system, costing billions of dollars yearly 25 , 26 . Moving towards equitable health systems that minimize the effects of racism and classism and maximize insurance-supported interventions, patients and families will progress toward improved health outcomes. The combination of healthcare cost savings and the expected future savings due to recidivism reduction 22 suggest that expanding evidence-based practices using public funding streams (e.g., CMS/CHIP) is warranted. Limitations Despite our thorough search for relevant studies with the assistance of an expert librarian, it is possible that relevant studies were missed. Our scoping review was limited to disparity reduction using specifically CMS-funded interventions and, therefore, did not explore other federally funded programs and their respective interventions. Conclusion Federal-funded programs, specifically CMS, can dismantle health inequities by addressing SDoH impacting minoritized and marginalized pediatric patients. Advancing pediatric healthcare equity requires recognizing disparities, aligning and modifying health systems, and implementing multifaceted targeted interventions through sustained community-based partnerships. Declarations Ethics approval and consent to participate: None Consent for publication: All authors consent to publication. Availability of data and materials: All data and materials provided or available upon request Competing interests: The authors declare that they have no relevant or material financial interests that relate to the research described in this paper. Funding: None Authors' contributions: CNM, MR, SD, RB, DD and LS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CNM, MR, SD, RB, DD, and LS contributed substantially to the study design, data analysis and interpretation, and manuscript writing. Acknowledgements: We would like to acknowledge the contribution of our librarian Michelle Keba Knecht, MSIS, MSL, AHIP References Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Healthy People 2020. https://www​.healthypeople.gov/ . Accessed October 3, 2023. Montoya-Williams D, Peña M-M, Fuentes-Afflick E. In Pursuit of Health Equity in Pediatrics. J Pediatr X. 2020;5:100045. AAP Equity Agenda. https://www.aap.org/en/about-the-aap/american-academy-of-pediatrics-equity-and-inclusion-efforts/aap-equity-agenda/ . Thornton RLJ, et al. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff Proj Hope. 2016;35:1416–23. Francis L, DePriest K, Wilson M, Gross DC, Poverty. Toxic Stress, and Social Determinants of Health: Screening and Care Coordination. Online J Issues Nurs. 2018;23:2. Beck AF, et al. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87:227–34. Bush ML, Kaufman MR, McNulty BN. Disparities in Access to Pediatric Hearing Healthcare. Curr Opin Otolaryngol Head Neck Surg. 2017;25:359–64. Spencer N, Raman S, O’Hare B, Tamburlini G. Addressing inequities in child health and development: towards social justice. BMJ Paediatr Open. 2019;3:e000503. sho21001_0.pdf. Williams JS, Walker RJ, Egede LE. Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges. Am J Med Sci. 2016;351:33–43. Peters MDJ, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18:2119. Silberberg M. Research translation: A pathway for health inequity. Clin Transl Sci. 2023;16:179–83. 2021 National Healthcare Quality and Disparities Report . (Agency for Healthcare Research and Quality (US), Rockville (MD), 2021). COMMITTEE ON CHILD HEALTH FINANCING. Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. Pediatrics. 2014;133:e784–93. Grace AM, Horn I, Hall R, Cheng TL. Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act. Pediatr Clin North Am. 2015;62:1297–311. Rudowitz R, Artiga S, Arguello R. Children’s Health Coverage: Medicaid, CHIP and the ACA. Published JP. The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us? KFF https://www.kff.org/medicaid/issue-brief/the-impact-of-the-childrens-health-insurance-program-chip-what-does-the-research-tell-us/ (2014). Ray KN, Mehrotra A, Yabes JG, Kahn JM. Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries. Acad Pediatr. 2020;20:642–51. LaClair M, et al. The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism. Health Serv Res. 2019;54:912–9. Doshi P, Tilford JM, Ounpraseuth S, Kuo DZ, Payakachat N. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? Matern Child Health J. 2017;21:351–66. Pate CA, Qin X, Bailey CM, Zahran HS. Cost barriers to asthma care by health insurance type among children with asthma. J Asthma. 2020;57:1103–9. Gottfredson DC, et al. Scaling-Up Evidence-Based Programs Using a Public Funding Stream: a Randomized Trial of Functional Family Therapy for Court-Involved Youth. Prev Sci. 2018;19:939–53. Kim SJ, et al. The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City. Fam Community Health. 2023;46:112–22. Kercsmar CM, et al. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community. JAMA Pediatr. 2017;171:1072–80. Health disparities cost the US billions every year. https://www.advisory.com/daily-briefing/2022/06/27/health-disparities . Shrank WH, et al. Health Costs And Financing: Challenges And Strategies For A New Administration. Health Aff (Millwood). 2021;40:235–42. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4095298","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":281642850,"identity":"4b298fe2-adf7-4686-a03a-4a24470337ef","order_by":0,"name":"Carlie N. Myers","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBAC/gYGxgMJMN4HBoYE3GqhQOIAAwNcC+MMYrQYOAC1wDjMPERpYT/74MCDCoZog+O9jz/b1Njl6bYfYHxc8QuPFp50gwMJZxhyN5w5biadcyy52OxMArPh2T48WhjSGA4ktgG13EhjY85tOJC47QYDm2RjDx4t/M+AWv4Btdx/xvzZkigtESBbGkC2sDFIM8K0NPzArUXiBtCWhGMSuTPPpLFJ9hxLTtx2JrHZsLEBtxb+/jTGhz9qbHL7jh9j/vCjxi5x2/HDBx82/MGtBWYZg8IBOIcRmCLaCGphYJBHdQphW0bBKBgFo2DkAAAoRluk2VBilAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Cincinnati College of Medicine Cincinnati","correspondingAuthor":true,"prefix":"","firstName":"Carlie","middleName":"N.","lastName":"Myers","suffix":""},{"id":281642852,"identity":"648a7fcb-01c1-461a-8276-2b38c5cfe29a","order_by":1,"name":"Meera Rao","email":"","orcid":"","institution":"Florida Atlantic University","correspondingAuthor":false,"prefix":"","firstName":"Meera","middleName":"","lastName":"Rao","suffix":""},{"id":281642853,"identity":"1cdf70c6-dab8-44b0-9c68-1be135906483","order_by":2,"name":"Sebastian Densley","email":"","orcid":"","institution":"Florida Atlantic University","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Densley","suffix":""},{"id":281642855,"identity":"f07def3c-d7c5-4808-9d0f-94e6646a7d0a","order_by":3,"name":"Rishiraj Bandi","email":"","orcid":"","institution":"Florida Atlantic University","correspondingAuthor":false,"prefix":"","firstName":"Rishiraj","middleName":"","lastName":"Bandi","suffix":""},{"id":281642856,"identity":"3e5a149f-4da1-40ae-89a0-a499e656f82d","order_by":4,"name":"Daniella Diaz","email":"","orcid":"","institution":"Florida Atlantic University","correspondingAuthor":false,"prefix":"","firstName":"Daniella","middleName":"","lastName":"Diaz","suffix":""},{"id":281642857,"identity":"9a586a9d-26a2-4dd5-af89-8c6e970f6c9f","order_by":5,"name":"Lea Sacca","email":"","orcid":"","institution":"Florida Atlantic University","correspondingAuthor":false,"prefix":"","firstName":"Lea","middleName":"","lastName":"Sacca","suffix":""}],"badges":[],"createdAt":"2024-03-13 18:29:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4095298/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4095298/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53265659,"identity":"ccc9efb5-0243-412a-8553-6398cdefc394","added_by":"auto","created_at":"2024-03-22 15:36:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":413088,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Diagram: Study Identification\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4095298/v1/912ac714ba6384b4646de440.jpeg"},{"id":55732954,"identity":"9425ba40-a406-438e-a97c-8d813d69ed1f","added_by":"auto","created_at":"2024-05-02 11:35:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":524620,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4095298/v1/2b1cad09-a22a-4cfb-a3c7-b4b3d2363c65.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Centers for Medicare and Medicaid Services (CMS) Supported Interventions to Address Health Disparities in Pediatric Populations: A Scoping Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare disparities are pervasive in marginalized and minoritized pediatric populations and lead to subsequent unjust differences in pediatric health outcomes.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The recent prioritization of the delivery of and access to equitable pediatric healthcare\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e has forced the examination of Center for Medicare and Medicaid Services\u0026rsquo; (CMS) role in reducing pediatric healthcare disparities.\u003c/p\u003e \u003cp\u003eSocial determinants of health (SDoH), \u0026ldquo; the conditions in the environment where people are born, live, play, work, learn, worship and age that affects a wide range of health, outcomes, and risks,\u0026rdquo; mediate health disparities. SDoH are drivers of disparities classified into five domains: healthcare access and quality, neighborhood and built environment, social and community context, education access and quality, and economic stability\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, all affecting the life-course trajectory of pediatric patients.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Those pediatric patients disadvantaged by racism and discrimination, socioeconomic status, geography, and environment all suffer poor health and health outcomes.\u003c/p\u003e \u003cp\u003ePoverty, affecting over 10\u0026nbsp;million children in the United States (US), limits a child\u0026rsquo;s access to healthcare and other positive SDoH, such as nutritious meals, education, violence-free neighborhoods, and healthcare services. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Marginalized, minoritized, and disenfranchised pediatric populations, including children of immigrants, those in foster care/houseless, those with disabilities, and those identifying as racial/ethnic and religious minorities, are the most likely to live below poverty and suffer persistent healthcare disparities. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Black, Hispanic, and Native American pediatric patients are more likely than their white counterparts to have poor health status and health outcomes. \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Governed by the societal distribution of power, money, and resources, racism and embedded poverty are foundational to the SDoH schema and pediatric healthcare disparities.\u003c/p\u003e \u003cp\u003eRecognizing the role of SDoH on pediatric health, CMS has committed to improving pediatric health outcomes by minimizing disparities and controlling healthcare costs.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This commitment has resulted in various delivery approaches, benefits, and reimbursement methodologies to improve state-level pediatric health outcomes. CMS additionally encourages individual states to evaluate interventions and initiatives to address SDoH, explicitly focusing on housing-related services and supports, non-medical transportation, home-delivered meals, educational services, employment, community integration and social support, and case management.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Despite a robust body of research demonstrating the role of SDoH on pediatric health and subsequent health disparities, few efforts have been made to translate such research into interventions aimed at pediatric health disparity reduction.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis scoping review identified CMS\u0026rsquo; role in reducing pediatric health disparities through evidence-based interventions. The evidence from this scoping review may guide and inform future CMS-supported state-level policies and initiatives to reduce healthcare disparities in pediatric populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe review team consisted of a group of researchers with medical and public health backgrounds who were selected based on their knowledge of federally funded health insurance's role in care delivery to pediatric patients in the United States. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) was used as a reference checklist in the development of the study sections.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e York methodology, and the updated criteria provided by the Joanna Briggs Institue were utilized as a framework to guide the review.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria:\u003c/h2\u003e \u003cp\u003eWe included peer-reviewed, full-text studies published in English between 2013 and 2023 focused on pediatric patients\u0026thinsp;\u0026lt;\u0026thinsp;18 years old highlighting disparity-reduction sponsored by CMS, including the Children\u0026rsquo;s Health Insurance Program (CHIP). Studies were excluded if the text was outside the period, not peer-reviewed, published in a language other than English, failed to include the target population, or disparity-reduction interventions funded by different mechanisms. Descriptive and observational studies (including narrative, systematic, and qualitative reviews) were excluded.\u003c/p\u003e \u003cp\u003eFour electronic databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to identify peer-reviewed articles from primary sources, secondary data sources, and case studies. The review of the literature was completed over one month, ending in June 2023. Articles were screened for eligibility by the primary author (CM) and senior author (LS). Data tabulation and extraction were carried out by co-authors (MR, SD, RB, and DD).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eKeywords and MeSH terms were developed with a research librarian experienced with scoping review protocols. Search terms focused on Medicaid, Medicare, CMS, CHIP, public health insurance, pediatric, juvenile, adolescent, pediatric patients, newborn, infant, neonate, health disparities, health inequality and inequity. Three benchmark articles were selected to validate the search for their focus on discrepancies between pediatric healthcare and public US insurance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Sources of Evidence\u003c/h2\u003e \u003cp\u003eAll co-authors (MR, SD, RB, and DD) extracted and summarized the data from relevant studies. The primary author (CM) and senior author (LS) reviewed all tabulated data to resolve any possible discrepancies. Summary tables consisted of one evidence table (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) describing the characteristics of the study, including contextual factors and intervention outcomes. The lessons learned from the thematic analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) were also included. Thematic analysis was carried out to identify similar themes and patterns in future directions across studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Evidence for CMS-supported interventions to minimize pediatric health disparities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Author (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePriority Population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy Purpose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStakeholders\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealth Care Disparities Addressed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRacine (2014)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolicy Statement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNear-poor children in the United States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1. To review the features of CHIP, summarize the program's effects on coverage, access, health status, and disparities among participants\u003c/p\u003e \u003cp\u003e2. To identify challenges in the provision of health insurance for vulnerable populations\u003c/p\u003e \u003cp\u003e3. Recommendations on how to expand and strengthen national commitment to providing health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eU.S. Federal Government; state-level government; policymakers; pediatricians; CHIP-eligible children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRacial/ethnic minorities, Socioeconomic status, non-citizens/immigrants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKercsmar (2017)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;36000 children and adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChildren and Adolescents with Asthma in Hamiton County, Ohio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTo test the implementation of a hospital-driven improvement\u003c/p\u003e \u003cp\u003ecollaborative associated with a reduction in acute asthma health\u003c/p\u003e \u003cp\u003ecare utilization in a population of Medicaid-insured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCincinnati Children\u0026rsquo;s Hospital Medical Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMedicare and Insurance Companies, Healthcare institutions, patients, and families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRacial/ethnic, Socioeconomic status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGottfredson (2018)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRandomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;129 families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJuvenile Justice-Involved Youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTo test the effects of a Functional Family Therapy (FFT) Program under contemporary natural conditions with at-risk children in urban minority populations that have a higher risk of gang involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSingle Courtroom in Philadelphia, PA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEducational Institutions, Juvenile Justice and Child Welfare Systems, adjudicated youth, and families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRacial/ethnic, Socioeconomic status, Neighborhood safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKim\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2023)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-Sectional Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;6458\u003c/p\u003e \u003cp\u003echildren and adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChildren and Adolescents from Disorganized Neighborhoods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTo test the effect of neighborhood disorganization on care engagement using a cohort of children with chronic conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eChicago, IL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFamilies and children from disorganized neighborhoods, local government, social Service providers, healthcare institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRacial/ethnic, Socioeconomic status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScoping Review Outcomes, Lessons Learned and Shared Themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Author (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcomes/Lessons Learned\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShared Themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRacine\u003c/p\u003e \u003cp\u003e(2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. State-by-state variability in cost sharing for CHIP stand-alone programs needs to be minimized to maintain true access to health care services, particularly pediatric subspecialty care.\u003c/p\u003e \u003cp\u003e2. Pediatricians and families must vigilantly assess the comprehensiveness of CHIP benefit packages.\u003c/p\u003e \u003cp\u003e3. Policymakers must set payment rates for pediatricians at adequate levels to maintain care for and engagement with CHIP enrollees.\u003c/p\u003e \u003cp\u003e4. Emancipated minors, children up to 26 years of age, foster youth, and children of undocumented immigrants should be monitored closely for eligibility and benefits.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e1. Community engagement measures taken by policymakers and medical institutions profoundly impact healthcare standards for underserved communities.\u003c/p\u003e \u003cp\u003e2. Increasing patient education and awareness about CMS improves care access rates.\u003c/p\u003e \u003cp\u003e3. Race and place of residence impact patient care engagement and the effects of healthcare interventions.\u003c/p\u003e \u003cp\u003e4. Increased insurance coverage improves care access for pediatric patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKercsmar (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Medications in hand at discharge mitigated a major barrier for the urban, indigent families in the study.\u003c/p\u003e \u003cp\u003e2. Using a care coordinator to facilitate an evidence-based care bundle led to reduced acute care service use by the highest-risk patients.\u003c/p\u003e \u003cp\u003e3. Following the QI framework with which interventions were developed and tested allowed for real-world, sustainable improvements to occur.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGottfredson (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. FFT-G was effective in reducing recidivism measured in official records.\u003c/p\u003e \u003cp\u003e2. The beneficial effects of the treatment were most evident after the intense surveillance period ended, and the treatment cases had to exercise their new skills to keep out of trouble.\u003c/p\u003e \u003cp\u003e3. The finding of no effects on hypothesized FFT-G mediators suggests that future research on FFT and family therapy should further investigate the timing of effects as well as the mechanisms leading to effects.\u003c/p\u003e \u003cp\u003e4. Youth who receive FFT-G are less likely to receive alternative, costly, public services during the time they are receiving FFT-G\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoss\u003c/p\u003e \u003cp\u003e(2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. Medicaid expansion has had generally positive effects on insurance coverage, in-hospital mortality, and access to rehabilitative care among young adult firearm trauma patients.\u003c/p\u003e \u003cp\u003e2. Medicaid expansion has had positive effects on insurance coverage and access to rehabilitative care. It has reduced some racial and socioeconomic disparities in these outcomes among young adult MVC trauma patients.\u003c/p\u003e \u003cp\u003e3. Future studies should evaluate Medicaid expansion's effects on firearm and MVC trauma patients' long-term health and functional, social, and economic outcomes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eData charting and collation, summarization, and reporting of results\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eStudy characteristics were tabulated to include the study's primary author, study type, sample size, target population, and study topic area. Lessons learned based on thematic analysis to identify common themes for future directions and recommendations across studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe screening process is outlined in the PRISMA diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The initial study extraction resulted in 1,577 articles from Pubmed (n\u0026thinsp;=\u0026thinsp;10), Embase (n\u0026thinsp;=\u0026thinsp;957), Web of Science (n\u0026thinsp;=\u0026thinsp;537), and Cochrane (n\u0026thinsp;=\u0026thinsp;73). Studies were excluded if they did not include Medicare or Medicaid-funded interventions to reduce healthcare disparities (n\u0026thinsp;=\u0026thinsp;811), focused on adult populations (n\u0026thinsp;=\u0026thinsp;355), or focused on maternal and child health rather than pediatric health outcomes (n\u0026thinsp;=\u0026thinsp;32). Duplicate studies were deleted (n\u0026thinsp;=\u0026thinsp;354). Twenty-five studies that met the inclusion criteria: Embase (n\u0026thinsp;=\u0026thinsp;19), PubMed (n\u0026thinsp;=\u0026thinsp;2), Web of Science (n\u0026thinsp;=\u0026thinsp;4), and Cochrane (n\u0026thinsp;=\u0026thinsp;0). An additional twenty-one studies were excluded following a full review; abstracts and not full text (n\u0026thinsp;=\u0026thinsp;18), reported interventions funded by mechanisms other than CMS (n\u0026thinsp;=\u0026thinsp;3). Consequently, a total of 4 studies were retained for analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe four included studies were published between 2013 and 2023. Study designs included a randomized control study (n\u0026thinsp;=\u0026thinsp;1), intervention study (n\u0026thinsp;=\u0026thinsp;1), cross-sectional study (n\u0026thinsp;=\u0026thinsp;1), and policy statement (n\u0026thinsp;=\u0026thinsp;1). Sample sizes ranged from 129 to 36,000, including low-income families, Medicaid-insured children and adolescents, and Children\u0026rsquo;s Health Insurance Program recipients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePriority Populations \u0026amp; Key Stakeholders\u003c/h2\u003e \u003cp\u003ePriority pediatric populations targeted through CMS-funded interventions were juvenile justice-involved youth (n\u0026thinsp;=\u0026thinsp;1), children and adolescents with asthma (n\u0026thinsp;=\u0026thinsp;1), and children and adolescents from disorganized neighborhoods (n\u0026thinsp;=\u0026thinsp;2) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Key stakeholders essential for intervention implementation included healthcare institutions (n\u0026thinsp;=\u0026thinsp;3), educational institutions (n\u0026thinsp;=\u0026thinsp;1), national and local politicians, policymakers, governmental programs (n\u0026thinsp;=\u0026thinsp;3), insurance companies (n\u0026thinsp;=\u0026thinsp;3), functions in juvenile justice (n\u0026thinsp;=\u0026thinsp;1), pediatricians and pediatrics-leaning medical students (n\u0026thinsp;=\u0026thinsp;1), vulnerable and hospitalized children and young adults (n\u0026thinsp;=\u0026thinsp;4), and families of pediatric patients (n\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e \u003cp\u003eThe results of these studies provide evidence of the role of SDoH and healthcare disparities for uninsured, minority, and low socioeconomic status patient populations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe aimed to assess CMS-funded interventions targeting disparity reduction in the pediatric population. While pediatric health research has progressed beyond disparity detection, evidence-based implementation of targeted interventions remains lacking.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e One obstacle of particular interest is that research translation can be inherently inequitable, as explained by the Fundamental Cause Theory of health disparities,\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e suggesting that equitable interventions for health disparities reduction require medico-social partnership, community engagement, and an intentional focus on minoritized and marginalized pediatric populations.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e The CMS-funded interventions highlighted in this scoping review have provided evidence that novel systematic approaches addressing disparities in pediatric healthcare are feasible, focusing on the importance of equity in healthcare access, medico-social context, and the cost savings of disparity reduction.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEquity in Healthcare Access\u003c/h2\u003e \u003cp\u003eHealth insurance, a foundational element of equity in access to healthcare, facilitates entry into the healthcare system. While health insurance is the foundation, pillars of healthcare access include having a medical home, feasibility and ease of seeking care and treatments, and receiving timely care.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The Committee on Child Health 15 statement explained the impact of increasing insurance for pediatric populations within CMS and the CHIP program in closing the equity gap\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Historically, pediatric patients have experienced disparities in access to care based on race, ethnicity, socioeconomic status, geographic location, and disability status. Sweeping healthcare reform in 1965 led to the enactment of Medicaid and Medicare, aligning federal-state and individual-level interests to provide health coverage for pregnant women, low- and middle-income children, and other vulnerable populations.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The CMS program has undergone several reforms, including the Affordable Care Act in 2010, to improve healthcare access for all, despite state-state variability in insurance coverage and benefits. Increased health insurance coverage has improved access and quality of care, in-hospital mortality, and access to rehabilitative care for pediatric patients\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. With telemedicine, Medicaid has recently targeted health disparity reduction in pediatric populations in rural or noncore geographic domains.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The need for increased coverage under public insurance, however, remains as children in rural communities face more barriers to care than their urban counterparts; recommendations include alternative forms of telemedicine and state-specific reductions of geographic restrictions.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Inequities in healthcare access are also apparent in children with autism spectrum disorder (ASD); increasing the Medicaid HCBS waiver generosity ameliorated the black-white disparity in unmet healthcare needs.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Meanwhile, state mandates for private insurance companies to provide services for children with ASD did not affect racial disparities, which could reflect the fact that children with ASD enrolled in Medicaid use more services than their privately insured counterparts.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e For children with asthma, those insured by Medicaid frequently visited the emergency department for uncontrolled asthma, where they then could not afford to fill given prescriptions, demonstrating a need for increased coverage.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eImportance of Medico-social Context\u003c/h2\u003e \u003cp\u003eCentral to each paper, community engagement measures taken by policymakers and medical institutions demonstrated a profound impact on the healthcare standard for underserved communities. Addressing medical mistrust through highly trained community health workers and bundling health care through a care coordinator are two examples of community engagement strategies that ultimately resulted in improved health outcomes within their communities. Additionally, community engagement through tailored medical policies that meet the needs of community members, such as providing inhalers at discharge to overcome a community pharmacy access barrier, was vital to observed improvements. Gottfredson and colleagues\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e presented the importance of family and community-oriented interventions on lowering adolescent delinquency while minimizing costs for the judicial and political system.\u003c/p\u003e \u003cp\u003eKim\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and colleagues' observational study analyzed the impact of neighborhood disorganization in local communities on a child\u0026rsquo;s trust and access to healthcare. The primary finding from this study highlights the possible interaction between neighborhood context and minority ethnicity backgrounds.\u003c/p\u003e \u003cp\u003eUsing similar hospital-driven implementation methods, Kercsmar\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e highlighted the treatment efficiency of medication-in-hand therapy and community screening guidelines for adolescent asthma intervention. With the improvement in healthcare utilization seen in such interventions, similar phased approaches are warranted for dealing with other common pediatric pathologies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDisparity Reduction and Cost Savings\u003c/h2\u003e \u003cp\u003eHealth disparities financially burden the patients, families, and the healthcare system, costing billions of dollars yearly\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Moving towards equitable health systems that minimize the effects of racism and classism and maximize insurance-supported interventions, patients and families will progress toward improved health outcomes. The combination of healthcare cost savings and the expected future savings due to recidivism reduction\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e suggest that expanding evidence-based practices using public funding streams (e.g., CMS/CHIP) is warranted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite our thorough search for relevant studies with the assistance of an expert librarian, it is possible that relevant studies were missed. Our scoping review was limited to disparity reduction using specifically CMS-funded interventions and, therefore, did not explore other federally funded programs and their respective interventions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFederal-funded programs, specifically CMS, can dismantle health inequities by addressing SDoH impacting minoritized and marginalized pediatric patients. Advancing pediatric healthcare equity requires recognizing disparities, aligning and modifying health systems, and implementing multifaceted targeted interventions through sustained community-based partnerships.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthics approval and consent to participate: None\u003c/li\u003e\n \u003cli\u003eConsent for publication: All authors consent to publication.\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials: All data and materials provided or available upon request\u003c/li\u003e\n \u003cli\u003eCompeting interests:\u0026nbsp;The authors declare that they have no relevant or material financial interests that relate to the research described in this paper.\u003c/li\u003e\n \u003cli\u003eFunding: None\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions:\u0026nbsp;CNM, MR, SD, RB, DD and LS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CNM, MR, SD, RB, DD, and LS contributed substantially to the study design, data analysis and interpretation, and manuscript writing.\u003c/li\u003e\n \u003cli\u003eAcknowledgements: We would like to acknowledge the contribution of our librarian Michelle Keba Knecht, MSIS, MSL, AHIP\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOffice of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Healthy People 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www​.healthypeople.gov/\u003c/span\u003e\u003cspan address=\"https://www​.healthypeople.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed October 3, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontoya-Williams D, Pe\u0026ntilde;a M-M, Fuentes-Afflick E. In Pursuit of Health Equity in Pediatrics. J Pediatr X. 2020;5:100045.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAAP Equity Agenda. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aap.org/en/about-the-aap/american-academy-of-pediatrics-equity-and-inclusion-efforts/aap-equity-agenda/\u003c/span\u003e\u003cspan address=\"https://www.aap.org/en/about-the-aap/american-academy-of-pediatrics-equity-and-inclusion-efforts/aap-equity-agenda/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThornton RLJ, et al. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff Proj Hope. 2016;35:1416\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancis L, DePriest K, Wilson M, Gross DC, Poverty. Toxic Stress, and Social Determinants of Health: Screening and Care Coordination. Online J Issues Nurs. 2018;23:2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck AF, et al. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87:227\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBush ML, Kaufman MR, McNulty BN. Disparities in Access to Pediatric Hearing Healthcare. Curr Opin Otolaryngol Head Neck Surg. 2017;25:359\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpencer N, Raman S, O\u0026rsquo;Hare B, Tamburlini G. Addressing inequities in child health and development: towards social justice. BMJ Paediatr Open. 2019;3:e000503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003esho21001_0.pdf.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams JS, Walker RJ, Egede LE. Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges. Am J Med Sci. 2016;351:33\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters MDJ, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18:2119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilberberg M. Research translation: A pathway for health inequity. Clin Transl Sci. 2023;16:179\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003e2021 National Healthcare Quality and Disparities Report\u003c/em\u003e. (Agency for Healthcare Research and Quality (US), Rockville (MD), 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOMMITTEE ON CHILD HEALTH FINANCING. Children\u0026rsquo;s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. Pediatrics. 2014;133:e784\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrace AM, Horn I, Hall R, Cheng TL. Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act. Pediatr Clin North Am. 2015;62:1297\u0026ndash;311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRudowitz R, Artiga S, Arguello R. Children\u0026rsquo;s Health Coverage: Medicaid, CHIP and the ACA.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePublished JP. The Impact of the Children\u0026rsquo;s Health Insurance Program (CHIP): What Does the Research Tell Us? \u003cem\u003eKFF\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kff.org/medicaid/issue-brief/the-impact-of-the-childrens-health-insurance-program-chip-what-does-the-research-tell-us/\u003c/span\u003e\u003cspan address=\"https://www.kff.org/medicaid/issue-brief/the-impact-of-the-childrens-health-insurance-program-chip-what-does-the-research-tell-us/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRay KN, Mehrotra A, Yabes JG, Kahn JM. Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries. Acad Pediatr. 2020;20:642\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaClair M, et al. The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism. Health Serv Res. 2019;54:912\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoshi P, Tilford JM, Ounpraseuth S, Kuo DZ, Payakachat N. Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? Matern Child Health J. 2017;21:351\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePate CA, Qin X, Bailey CM, Zahran HS. Cost barriers to asthma care by health insurance type among children with asthma. J Asthma. 2020;57:1103\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGottfredson DC, et al. Scaling-Up Evidence-Based Programs Using a Public Funding Stream: a Randomized Trial of Functional Family Therapy for Court-Involved Youth. Prev Sci. 2018;19:939\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SJ, et al. The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City. Fam Community Health. 2023;46:112\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKercsmar CM, et al. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community. JAMA Pediatr. 2017;171:1072\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth disparities cost the US billions every year. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.advisory.com/daily-briefing/2022/06/27/health-disparities\u003c/span\u003e\u003cspan address=\"https://www.advisory.com/daily-briefing/2022/06/27/health-disparities\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrank WH, et al. Health Costs And Financing: Challenges And Strategies For A New Administration. Health Aff (Millwood). 2021;40:235\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CHIP, Medicare, CMS, public insurance, pediatric, health disparities, health inequities","lastPublishedDoi":"10.21203/rs.3.rs-4095298/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4095298/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eOBJECTIVE: \u003c/strong\u003eTo assess the scope of Centers for Medicaid and Medicare (CMS) and CHIP funded interventions to minimize pediatric health disparities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS: \u003c/strong\u003eThe authors searched\u003cstrong\u003e \u003c/strong\u003eCochrane Library, Embase, PubMed, and Web of Science using keywords and terms related to Medicaid, Medicare, CMS, public health insurance, pediatric, and health disparities. Full-text, peer-reviewed studies published in English between 2013-2023 focusing on pediatric patients with interventions to reduce health disparities funded by CMS were included. The review of the literature databases was completed over one month, ending in June 2023. Articles were screened for eligibility by the primary author and senior author. Co-authors carried out data tabulation and extraction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eFour peer-reviewed, full-text studies published in English between 2013-2023 that focused on pediatric patients (0-18 years old) with public health insurance with interventions to reduce health disparities funded by CMS were included in the review. Study designs included one randomized control study, one intervention study, one cross-sectional study, and one policy statement. Patient sample sizes ranged from 129 to 36,000, including racial/ethnic minorities, low-income families, Medicaid-insured children and adolescents, and Children’s Health Insurance Program recipients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION: \u003c/strong\u003eFew studies exist examining CMS-funded interventions to minimize pediatric health disparities. Federal-funded programs, specifically CMS, can dismantle health inequities by addressing SDoH impacting minoritized and marginalized pediatric patients.\u003c/p\u003e","manuscriptTitle":"Centers for Medicare and Medicaid Services (CMS) Supported Interventions to Address Health Disparities in Pediatric Populations: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 15:36:41","doi":"10.21203/rs.3.rs-4095298/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4455d1cd-aa48-44f8-9380-4d166f075b7f","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-02T11:35:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 15:36:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4095298","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4095298","identity":"rs-4095298","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}