Medicaid Funded Child Restraints

Background

Motor vehicle traffic crashes are the leading cause of unintentional injury-related death for children ages four and under. In 1997, 483 children ages four and under died as occupants in motor vehicle crashes (1). Unrestrained children are more likely to be injured, to suffer more severe injuries, and to die in motor vehicle crashes than children who are restrained.

The results of several studies support that children of families receiving Medicaid do not always travel safely in motor vehicles. One study found that 68.5 percent of birth to three year-olds receiving Medicaid services in Memphis, Tennessee travel in automobiles without adequate protection (2). The authors of another study suggest that about 60 percent of children ages birth to four on Medicaid travel unrestrained while only 10-15 percent of other children travel unrestrained (3). Other researchers reported that for those respondents in their study who did not have a car seat, cost was cited as the most frequent reason (71 percent) for not having one (4).

Policies

Medicaid programs should support the cost of size-appropriate restraints for children of eligible families and the hands-on training necessary to use the restraints correctly.

The Health Care Finance Administration should allow federal Medicaid reimbursement for infant and child safety seats as durable medical goods. Low-income families should not be put at additional risk for lifelong disabilities or even death simply because they may not be able to afford reliable safety seats for their families. Medicaid coverage of child restraints may also alleviate the problem of unsafe secondhand car seats being resold.

Many states are not able to provide comprehensive, statewide child safety seat programs and training due to lack of adequate resources. State programs with funds allocated specifically towards the provision of car seats could reallocate these resources toward additional child safety seat programs and training if federal Medicaid reimbursement for child restraint systems and training in their use were mandated.

The American Academy of Pediatrics, the American Public Health Association, the Association of State and Territorial Health Officers, and the State and Territorial Injury Prevention Directors' Association have passed resolutions that encourage Medicaid to include child restraint systems as a benefit of coverage (5, 6, 7, 8).

Effectiveness Data

Child safety seats are extremely effective when correctly installed and used in passenger cars. Research on the effectiveness of child safety seats has found that they reduce the risk of fatal injury by 69 percent for infants (less than one year old) and by 47 percent for toddlers (one to four years old) (9). If all child passengers ages five and under were properly restrained, it is estimated that an additional 183 lives could have been saved in 1997 alone (10).

Over a four-year average, a $50 safety seat for a child on Medicaid can save almost $100 in medical costs and $1,400 in preserved good health (11). Medicaid could experience net cost savings by averting expensive medical costs with support for the purchase of safety seats and training to use them properly.

Contacts

Leroy Frazier
Injury Prevention Program
South Carolina State Department of Health & Environmental Control
Phone: (803) 898-0314
E-mail: FRAZIEL@columb61.dhec.state.sc.us

David Lawrence, Center Director
Center for Injury Prevention Policy and Practice
San Diego State University
6505 Alvarado Road, Suite 208
San Diego, CA 92120
Phone: (619) 594-3691
Fax: (619) 594-1994
E-mail: dlawrenc@mail.sdsu.edu
Web site: http://www.cippp.org

References

1. Occupant Deaths and Rates per 100,000. United States MV Traffic. Office of Statistics and Programming, National Center for Injury Prevention and Control, CD,. 1997. Web site: http://http://www.cdc.gov/ncipc/wisqars, April 4, 2000.
   
   
2. Sharp GB and Carter MA. Use of Restraint Devices to Prevent Collision Injuries and Deaths Among Welfare-Supported Children. Public Health Reports. 107 (1): 116-18, 1992.
   
   
3. Miller T, Demes J and Bovbjerg R. Child Seats: How Large Are the Benefits and Who Should Pay? Proceedings of the AAAM-STAPP-ICROBI Child Occupant Protection Sessions. Child Occupant Protection, SP-986. Society for Automotive Engineering, Warrendale, PA, November 1993.
   
   
4. Radius SM, McDonald EM and Bernstein L. Influencing Car Safety Seat Use: Prenatal and Postnatal Predictors. Health Values, 1991. 15 (4): 29-38.
   
   
5. American Academy of Pediatrics. Safe Transportation of Newborns at Hospital Discharge (RE9854). Pediatrics, 1999. 104 (4): 986-987. Web site: http://www.aap.org/policy/RE9854.html, April 4, 2000.
   
   
6. American Public Health Association. 9307: Health Insurance Coverage for Child Safety Interventions. American Journal of Public Health, 1994. 84 (3): 515-6.
   
   
7. Association of State and Territorial Health Officers, Executive Committee. Recommendations from the Injury Prevention Task Force and ASTHO Prevention Policy Committee. ASTHO Report, 1999. 7(19) :5.
   
   
8. Child Safety Seat Availability and Training. The State and Territorial Injury Prevention Directors' Association. Web site: http://www.stipda.org/resol/99css.htm, February 21, 2000.
   
   
9. Traffic Safety Facts 1997: Children. National Highway Traffic Safety Administration. DOT HS 808 765.
   
   
10. Traffic Safety Facts 1997: Children. National Highway Traffic Safety Administration. DOT HS 808 768.
    
    
11. Miller T and Levy D. Cost-Outcome Analysis in Injury Prevention and Control: 84 Recent Estimates for the United States. Medical Care, 2000. 38 (6): 562-582.
    
    

Acknowledgements

Leroy Frazier. Jr., M.S.P.H., C.H.E.S., Director, South Carolina Dept. of Health and Environmental Control, Injury & Disability Branch, Columbia, SC.
 
Chris Hanna, M.P.H., National Children's Center for Rural and Agricultural Health Safety, Marshfield, WI.
 
Diane Winn, M.P.H., R.N., University of California-Irvine, Pediatric Injury Prevention Research Group, Irvine, CA.
 
David F. Zane, M.S., Director, Texas State Department of Health, Injury Epidemiology and Surveillance Program, Austin, TX.

We extend special thanks to the California Center for Childhood Injury Prevention (CCCIP) for their extensive contribution and commitment to the production of this publication.