Publication date: Jul 30, 2025

This study identifies factors associated with hospitalization and examines the moderating effects of South Carolina Medicaid’s Medically Complex Children’s Waiver (MCCW) enrollment and receipt of home nursing care (HNC) on hospitalization risk among Medicaid-insured children with medical complexity in South Carolina from 2019 to 2022. We analyzed retrospective Medicaid claims data from 783 149 billed home health care claims among 4484 children aged 0 to 21 years in South Carolina from 2019 to 2022. The outcome of interest was experiencing at least 1 hospitalization from 2019 to 2022. The Pediatric Medical Complexity Algorithm version 3. 0 was applied, using International Classification of Diseases, Tenth Revision (ICD-10) codes to classify diagnoses as either a complex chronic disease (C-CD) or a noncomplex chronic disease (NC-CD). Children with a C-CD aged 0 to 4 and 20 to 21 years who identified with a race and ethnicity other than non-Hispanic white, were primarily insured by Medicaid, and received services in 2020 and 2021 had significantly higher hospitalization risk compared with other children. Controlling for MCCW, HNC had a mediating effect on hospitalization risk for CMC with a C-CD (odds ratio [OR] 1. 03, 95% CI: 1. 02-1. 04, compared with children with an NC-CD). Children with a C-CD who received HNC had significantly lower hospitalization risk (adjusted OR [AOR] 0. 87, 95% CI: 0. 85-0. 89) compared with children with an NC-CD. Children who received HNC in 2020 (AOR 0. 90, 95% CI: 0. 84-0. 96) and 2021 (OR 0. 92, 95% CI: 0. 86-0. 98) had significantly lower odds of hospitalization(s) compared with those without nursing in 2019. MCCW enrollment lowers hospitalization risk to an extent; however, HNC may have reduced hospitalization risk throughout the COVID-19 pandemic. Further research is needed to understand the intricacies of South Carolina Medicaid’s MCCW and to improve health among Medicaid-insured children in South Carolina.

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Original Article