Medicaid-insured kids with anorexia face longer hospital stays

Medicaid-insured kids with anorexia hospitalized for medical stabilization remain in hospital longer than peers with private insurance despite similar illness severity, according to a study from Ann & Robert H. Lurie Children's Hospital of Chicago published in the Journal of Eating Disorders. Authors highlight poor access to post-discharge care – such as residential treatment, partial hospitalization or outpatient services – as the most likely reason for the disparity.

We found that a financial issue is causing a concerning inequity in anorexia care. Medicaid too often does not cover needed services for anorexia, or the problem might be that reimbursement to providers is so low that many anorexia programs don't accept patients covered by Medicaid."

Gregg Montalto, MD, MPH, Senior Author, Associate Division Head for Clinical Practice, Adolescent and Young Adult Medicine at Lurie Children's and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine

"Given that anorexia is the second most lethal psychiatric illness after opioid use disorder, and it's in the ballpark of some childhood cancers in terms of mortality risk, we urgently need better coverage and reimbursement from Medicaid for the treatment these kids require," he added.

Eating disorders lead to 10,200 deaths per year in the United States, most of those due to complications of anorexia nervosa. Patients with anorexia have an irrational fear of eating and gaining weight, which can lead to starvation and a medical crisis, such as failing kidneys or extremely low blood pressure.

"Patients with anorexia nervosa need to eat in order to live," stressed Dr. Montalto. "We are talking about a life-threatening illness that needs to be approached as such by all payors and especially by Medicaid."

Currently there is no effective medication for anorexia, and as Dr. Montalto says, "the most important medicine is food." However, since eating is the primary challenge in this case, patients might need tube feeding to maintain physical stability.

For the study, Dr. Montalto and colleagues performed a retrospective chart review of 139 adolescent and young adult patients admitted a combined 196 times for medical instability due to anorexia at Lurie Children's. Researchers examined differences in length of hospital stay and reimbursement rates based on payor type (public vs. private), while controlling for demographic and clinical factors that may impact length of stay.

While length of stay was significantly greater for Medicaid-insured patients, Medicaid reimbursement was found to be nearly five times lower per hospital day compared to private insurance reimbursement.

"There is stark inequity in anorexia care that must be addressed," said Dr. Montalto. "Kids with anorexia deserve so much more from our healthcare system. We hope that our findings will inspire advocacy for changes in Medicaid coverage for anorexia treatments."