Changes in Use and Access to Care for Children and Youth With Special Health Care Needs During the COVID-19 Pandemic.

INTRODUCTION: Children and youth with special health care needs (CYSHCN) are vulnerable to health care disruption, and policies were adopted to mitigate COVID-19-related disruptions. We compare CYSHCN use of and access to care in 2019 to 2020.
METHOD: Using the National Survey of Children's Health, we identified CYSHCN and assessed differences in health care use, unmet health care needs, frustrations accessing care, and barriers to care using multivariable logistic regression analysis.
RESULTS: The final sample included 17,065 CYSHCN. In the fully adjusted analysis, there was a significant decrease in odds of accessing preventive dental care (adjusted odds ratio [AOR], 0.63; 95%confidence interval [CI], 0.51-0.77) and increased odds of unmet mental health care needs (AOR,1.34; 95% CI, 1.02-1.77). The inability to obtain an appointment was a barrier that increased during the study period (AOR, 2.77; 95% CI, 1.71-4.46). DISCUSSION: Novel pandemic related policies may have mitigated negative impacts on health care access for CYSHCN.

The coronavirus disease 2019 (COVID-19) pandemic had profound effects on child health and well-being. Disruptions in school and alterations in socialization contributed to worsening child mental health (Cutler et al., 2022; Howard-Jones et al., 2021; Shankar et al., 2022). There were also changes in utilization of pediatric primary care, including decreased use of preventative care and receipt of routine vaccinations (Lebrun-Harris et al., 2022; Schweiberger et al., 2021). These changes culminated in significant increases in unmet pediatric healthcare needs.

A focal subpopulation of nearly 14 million children is children and youth with special health care needs (CYSHCN). These CYSHCN have a diverse range of health conditions and care needs but all have one or more chronic physical, development, behavioral, or emotional condition and require more health services that the average child (Health Resources and Services Administration [HRSA], 2021). However, while CYSHCN have greater needs for health services, they routinely have higher rates of unmet needs with notable age and racial disparities (Ghandour, Hirai, & Kenney, 2022; Kuo et al., 2014). In addition, a majority of CYSHCN do not receive care in a functioning health system (Yu et al., 2021; Ghandour et al., 2022). As a result, CYSHCN had increased vulnerability to COVID-19 related disruptions and changes in health care delivery (Mitchell, 2021). In response, state and federal policymakers attempted to mitigate the effects of the COVID-19 pandemic on access to care for CYSHCN through multiple legislative and regulatory changes (see Table 1 ) (Sillow-Carroll et al., 2021).

Table 1

Illustrative legislative, regulatory, and executive policy response address pediatric access to care during the COVID-19 pandemic.

Area of Intended Policy Intervention	Policy
Telehealth Utilization	• Coronavirus Preparedness and Response Supplemental Appropriations Act • Coronavirus Aid, Relief and Economic Security (CARES) Act • Consolidated Appropriations Act of 2021 • American Rescue Plan Act of 2021 • Improving Rural Health and Telehealth Access Executive Order
Medicaid and CHIP Eligibility or Payment	• Families First Coronavirus Response Act • CARES Act • Section 1135 waiver (50 states and Washington D. C.) • Disaster-Relief Medicaid State Plan Amendment (47 states and Washington D. C.) • Children's Health Insurance Plan State Plan Amendment (35 states) • Appendix K of Section 1915(c) Home and Community Based Services waivers (50 states and Washington D. C.) • COVID-19 Public Health Emergency Demonstration Section 1115 waivers (11 states)
Mental Health Care Delivery	• American Rescue Plan Act of 2021
Workforce Availability	• Paycheck Protection and Health Care Enhancement Act • 2021 Medicare Physician Fee Schedule Final Rule • Governors’ Executive Orders addressing state-scope of practice (23 states)

(Silow-Carroll et al., 2021; Poghosyan et al., 2022)

Yet it is unclear how effective these policy changes were in realizing access to care for CYSHCN. To address this gap in knowledge, we evaluated changes in access to care for CYSHCN during the first year of the COVID-19 pandemic and examined barriers to accessing needed health services as a mechanism to evaluate the impact of the COVID-19 related policy changes.

Methods

This study drew on pooled 2019-2020 data from the publicly available National Survey of Children's Health (NSCH). This population-based survey is conducted annually by the US Census Bureau for the US Department of Health and Human Services, Health Resources and Services Administration, and Maternal and Child Health Bureau. The survey data offers detailed information on children's health and mental health status, health care and support service experiences, and social and environmental context. It is weighted to enable generation of state and nationally representative estimates representing the population of non-institutionalized children, ages 0 through 17 years old, living in housing units in the United States (Ghandour et al., 2018). This analysis focused on the subsample of CYSHCN within the NSCH. The NSCH uses the Child with Special Health Care Needs screening tool, which is described in detail elsewhere (Bethell et al., 2015), to identify CYSHCN. Survey design and administration is also detailed elsewhere (Ghandour et al., 2018).

Key Variables

The dependent variables used in this study, the survey item measuring them, and the structure of each, is listed in the online supplement (Appendix A). Appendix A also describe the structure of two control variables: whether the child has an emotional, behavioral, and developmental problems and complexity of needs. Additional control variables included child demographics, including sex, age, and race and ethnicity. Family resources covariates included caregiver education level, household language, household, family, type of child's health insurance, and continuity of child's health insurance. The predictor variable in this analysis was the year of data collection.

Analysis

The study sample included all children in the datasets, years 2019 and 2020, who met the criteria for having special health care needs (n=17,065). Analyses were conducted in STATA MP 16.1 and accounted for the survey's complex sampling design and weighting, allowing for national estimates in analytic outcomes. Less than 5% of the sample was missing non-imputed data for other individual covariates and outcome variables, and these observations were excluded from multivariable analysis. Up to 10% of observations with missingness can be dropped without compromising the national representativeness of the data, its weighing, and related analytic outcomes (Langkamp et al., 2010).

Among CYSHCN, we conducted univariate and bivariate analysis to assess for significant differences in frequencies of all dependent variables and covariates comparing CYSHCN across 2019 and 2020. Chi-squares estimated significance of differences across years. Fixed effects multivariable logistic regression models estimated the association between change in year and reported unmet healthcare needs and difficulties or frustrations in accessing care or referrals for care. Bivariate analysis and fixed effects multivariable logistic regression analysis examined experience of specific barriers to health care among CSHCN with any unmet need for health care (n=1,207).

Results

Children and Youth Characteristics

There were 17,065 children and youth with special health care needs included in the 2019 and 2020 survey sample. The characteristics of CYSHCN were generally comparable between 2019 and 2020 with two notable exceptions (Table 2 ). In 2020, CYSHCN had more ongoing emotional, behavioral, or developmental problems (45.1% vs 50.6%, p = 0.001) and more complexity of needs (70.4% vs. 75.1%, p = 0.001). There were no significant changes in insurance coverage type or continuity and household income from 2019 to 2020.

Table 2

Demographic characteristics of children and youth with special health care needs included in the 2019 and 2020 National Survey of Children's Health.

Characteristic	TotalN = 17,065*	2019N = 7,021	2020N = 10,044	P-Value
	N (weighted %)	weighted %	weighted %
Age0-5 years6-11 years12-17 years	2,391 (17.5)5,708 (37.0)8,966 (45.6)	17.436.845.8	17.537.145.4	0.97
Sex (male)	9,696 (58.2)	58.3	58.1	0.91
RaceWhite, non-HispanicBlack, non-HispanicHispanicOther/Multiracial	11,817 (52.3)1,296 (16.0)2,023 (22.3)1,929 (9.4)	52.815.621.99.7	51.916.422.69.2	0.80
Insured Continuous in Past 12 Months (yes)	16,099 (93.5)	93.6	93.5	0.88
Type of InsurancePublicPrivatePublic and PrivateNot Insured	4,558 (36.4)10,494 (51.0)1,228 (8.6)576 (3.9)	36.651.68.33.5	36.350.58.94.4	0.57
Child has Ongoing Emotional, Behavioral or Developmental Problem (yes)	7,895 (47.9)	45.1	50.6	0.001
Complexity of NeedsLess Complex NeedsMore Complex Needs	4,903 (27.2)12,162 (72.8)	29.670.4	24.975.1	0.001
Parent Education LevelLess than High SchoolMore than High School	2,630 (27.1)14,435 (72.9)	26.273.8	27.972.1	0.31
Family StructureSingle Parent or Other StructureTwo Parent Family	4,920 (33.9)11,778 (66.1)	33.766.3	34.165.9	0.83
Household LanguageEnglishNot English	16,378 (92.7)616 (7.3)	93.26.8	92.27.8	0.37
Household Income0-99% FPL100-199% FPL200-399% FPL400% FPL or above	2,326 (21.6)3,017 (21.7)5,252 (27.8)6,470 (28.9)	22.721.226.929.3	20.622.128.828.5	0.35

Variable sample size does not always equal total sample size due to variation in response rate across variables.

Health Care Utilization and Access to Care

In unadjusted analysis, from 2019 to 2020, there was a statistically significant decrease in rates of preventive medical visits (89.8% in 2019 to 87.5% in 2020, p = 0.04) and preventive dental visits (85.4% in 2019 to 78.5% in 2020, p < 0.001) (Table 3 ). There was also a statistically significant increase in rate of unmet mental health care need (5.1% in 2019 to 7.0% in 2020, p = 0.01). There were no statistically significant changes with respect to unmet need for health care, use of specialty care, or frustration obtaining medical services.

Table 3

Health care utilization, access to care and experiences obtaining care among children and youth with special health care needs from 2019 to 2020.

Outcome		Total*N = 17,065	2019N = 7,021	2020N = 10,044	P-Value
		N (weighted %)	weighted %	weighted %
At least one preventative care visit	NoYes	1,776 (11.4)15,216 (88.6)	10.389.8	12.587.5	0.04
At least one preventative dental visit	NoYes	2,292 (18.1)14,587 (81.9)	14.685.4	21.578.5	<0.001
Any unmet health care need	NoYes	15,797 (91.2)1,212 (8.8)	91.48.6	91.18.9	0.82
Any unmet mental health care need	NoYes	16,042 (93.9)952 (6.1)	94.95.1	93.07.0	0.01
Unmet need for specialist care	NoYes	16,379 (94.6)573 (5.4)	94.35.7	94.95.2	0.56
Experienced frustration in accessing care	NoYes	15,210 (86.9)1,819 (13.1)	86.213.8	87.712.4	0.27
Experienced difficulty obtaining referrals for specialist care	NoYes	15,511 (90.0)1,458 (10.0)	90.49.6	89.710.3	0.49
Experienced difficulty accessing specialist care	NoYes	14,915 (88.0)1,969 (12.0)	87.912.1	88.012.0	0.94

Variable sample size does not always equal total sample size due to variation in response rate across variables.

In the fully adjusted analysis, significant differences in utilization of preventative dental care (adjusted odds ratio [AOR]: 0.63, 95% CI 0.51 – 0.77, p < 0.001) persisted as did unmet health mental health care needs (AOR: 1.34, 95% CI: 1.02 – 1.77, p = 0.04) from 2019 to 2020 (Table 4 ). Parents of CYSHCN reported no significant change in accessing preventative care and reported no significant changes in unmet need for health care or specialist care. Further, rates of reported frustration in accessing care, difficulty in accessing specialist care, and difficulty in obtaining referrals did not change significantly among parents of CYSHCN (Appendix B).

Table 4

Results of the logistic regression analyses examining health care utilization and access to care from 2019 to 2020 among children and youth with special health care needs.

Characteristic	1+ PreventativeCare Visit		1+ PreventativeDental Visit		Any UnmetHealth Care Need		Any Unmet Mental Health Care Need		Unmet Need for Specialist Care
	Odds Ratio(95% CI)	p-Value	Odds Ratio(95% CI)	p-Value	Odds Ratio(95% CI)	p-Value	Odds Ratio(95% CI)	p-Value	Odds Ratio(95% CI)	p-Value
Year20192020	REF0.84 (0.67-1.05)	0.12	REF0.63 (0.51-0.77)	<0.001	REF1.07 (0.79-1.46)	0.65	REF1.34 (1.02-1.77)	0.04	REF0.83 (0.57-1.22)	0.33
Age0-5 years6-11 years12-17 years	REF0.59 (0.40-0.88)0.39 (0.26-0.57)	0.01<0.001	REF4.43 (3.39-5.78)3.23 (2.47-4.21)	<0.001<0.001	REF1.07 (0.64-1.80)1.15 (0.68-1.96)	0.790.60	REF1.51 (0.95-2.39)1.51 (1.00-2.30)	0.080.05	REF1.95 (1.13-3.38)1.39 (0.78-2.49)	0.020.26
SexMaleFemale	REF1.31 (1.05-1.64)	0.02	REF1.08 (0.88-1.33)	0.48	REF1.19 (0.86-1.64)	0.30	REF1.11 (0.85-1.44)	0.44	REF1.27 (0.85-1.89)	0.24
RaceWhite, non-HispanicBlack, non-HispanicHispanicOther/Multiracial	REF1.17 (0.82-1.68)0.87 (0.60-1.26)0.77 (0.56-1.05)	0.390.460.10	REF0.77 (0.58-1.03)0.91 (0.66-1.27)0.96 (0.72-1.29)	0.080.910.96	REF0.81 (0.53-1.24)1.13 (0.67-1.90)1.30 (0.81-2.09)	0.320.650.28	REF1.47 (1.00-2.16)0.83 (0.55-1.25)1.38 (0.80-2.36)	0.050.370.25	REF1.60 (1.00-2.57)2.22 (1.18-4.17)1.36 (0.78-2.38)	0.050.010.28
Insured Continuous in Past 12 MonthsYesNo	REF1.15 (0.59-2.24)	0.69	REF0.63 (0.34-1.16)	0.14	REF3.81 (2.02-7.17)	<0.001	REF1.81 (0.95-3.46)	0.07	REF1.97 (0.99-3.93)	0.05
Type of InsurancePrivatePublicPublic and PrivateNot Insured	REF1.18 (0.88-1.60)0.79 (0.51-1.24)0.41 (0.19-0.86)	0.270.310.02	REF0.75 (0.54-1.04)0.81 (0.54-1.21)0.53 (0.26-1.09)	0.080.300.08	REF0.97 (0.60-1.56)1.41 (0.74-2.68)0.89 (0.40-1.98)	0.890.300.78	REF1.10 (0.77-1.56)0.98 (0.53-1.84)1.14 (0.48-2.71)	0.600.960.76	REF0.72 (0.42-1.23)1.02 (0.50-2.08)0.91 (0.37-2.23)	0.230.960.83
Child has Ongoing Emotional, Behavioral or Developmental ProblemNoYes	REF0.84 (0.65-1.10)	0.20	REF0.90 (0.70-1.16)	0.41	REF2.26 (1.46-3.50)	<0.001	REF2.97 (2.08-4.24)	<0.001	REF2.06 (1.32-3.22)	0.002
Complexity of NeedsLess Complex NeedsMore Complex Needs	REF1.06 (0.78-1.43)	0.72	REF0.96 (0.73-1.27)	0.79	REF1.56 (0.83-2.94)	0.17	REF1.92 (1.11-3.30)	0.02	REF1.20 (0.55-2.63)	0.65
Parent Education LevelLess than High SchoolMore than High School	REF1.70 (1.28-2.25)	<0.001	REF1.79 (1.36-2.36)	<0.001	REF1.28 (0.76-2.15)	0.36	REF1.26 (0.90-1.78)	0.18	REF10.1 (0.67-1.51)	0.97
Family StructureSingle Parent or OtherTwo Parent Family	REF1.57 (1.22-2.02)	<0.001	REF0.86 (0.68-1.09)	0.21	REF1.05 (0.76-1.45)	0.79	REF0.92 (0.67-1.26)	0.59	REF0.98 (0.65-1.48)	0.92
Household LanguageNot EnglishEnglish	REF1.12 (0.68-1.86)	0.66	REF0.68 (0.41-1.14)	0.15	REF1.29 (0.57-2.94)	0.54	REF0.94 (0.47-1.90)	0.87	REF1.01 (0.43-2.38)	0.99
Household Income0-99% FPL100-199% FPL200-399% FPL400% FPL or above	REF1.30 (0.93-1.80)1.21 (0.85-1.73)1.67 (1.15-2.44)	0.120.280.008	REF(0.73-1.37)1.23 (0.89-1.71)2.01 (1.41-2.88)	0.990.22<0.001	REF1.13 (0.63-2.02)0.84 (0.46-1.51)0.53 (0.28-0.99)	0.690.560.05	REF0.64 (0.42-0.98)0.79 (0.51-1.23)0.71 (0.41-1.21)	0.040.300.20	REF0.72 (0.46-1.11)1.03 (0.55-1.94)0.57 (0.29-1.11)	0.140.930.10

We identified characteristics associated with decreased utilization and access to care as well as protective characteristics associated with receipt of needed care. With regards to receiving preventative health and dental care, CYSHCN were statistically significantly less likely to receive preventive care if they were older or uninsured (Table 4). In addition, Black CYSHCN had greater odds of unmet mental health care and Black and Hispanic CYSHCN had greater unmet need for specialist care (p ≤ 0.05). However, greater parental education and household income was associated with statistically significantly greater odds of receiving preventive health and dental care (p < 0.01).

Further, CYSHCN who did not have continuous insurance coverage were more likely to have unmet needs for health care (AOR 3.81, p < 0.001) and unmet needs for specialist care (AOR 1.97, p = 0.005). The presence of an ongoing emotional, behavioral or developmental problem was associated with greater odds of unmet health care needs (AOR: 2.26, p < 0.001), unmet mental health care needs (AOR: 2.97, p < 0.001) and unmet needs for specialist care (AOR: 2.06, p = 0.002). In addition, CYSHCN had greater odds of unmet mental health care if they had more complexity of needs (AOR: 1.92, p = 0.02).

There was greater frustration obtaining care for CYSHCN among key populations (Appendix B). Specifically, CYSHCN who were not continuously insured had statistically significantly greater frustration accessing care (AOR 3.01), obtaining referrals for specialist care (AOR 3.49), and accessing specialist care (AOR 3.26) (all p < 0.001). Those CYSHCN with more medical complexity had statistically significantly greater frustration accessing care (AOR 1.85, p = 0.02), obtaining referrals for specialist care (AOR 2.73, p < 0.001), and accessing specialist care (AOR: 3.25, p < 0.001).

Barriers to Health Care

Among those who reported unmet health care needs (n = 1207), the most reported barriers to care in 2019 and 2020 were problems with the cost of care and problems obtaining an appointment (Table 5 ). From 2019 to 2020 there were statistically significant changes in unadjusted odds of CYSHCNs’ inability to obtain an appointment (OR: 2.75, p < 0.001) and offices being closed (OR: 4.18, p < 0.001). However, when adjusting for patient and family characteristics, CYSHCN with unmet health care needs only had statistically significantly greater odds of not being able to obtain an appointment (AOR: 2.77, p < 0.001). Notably, from 2019 to 2020, among CYSHCN with unmet health care needs, there was a statistically significant decrease in odds of being ineligible for services (AOR: 0.52, p = 0.02). There were no significant changes in other reported barriers to care including cost or service availability.

Table 5

Unadjusted and Adjusted Rates of Parent-Reported Barriers to Health Care for CSHCNs with Unmet Healthcare Needs, 2019 to 2020.

Barrier to Health Care	2019N= 443	2020N= 707	Change from2019 to 2020		Adjusted Change from2019 to 2020
	Weighted %(95% CI)	Weighted %(95% CI)	Odds Ratio(95% CI)	P-Value	Adjusted Odds Ratio*(95% CI)	P-Value
Ineligible for Services	40.6(30.0-52.1)	29.3(20.8-39.5)	0.61(0.32-1.16)	0.13	0.53(0.30-0.91)	0.02
Unable to Obtain an Appointment	41.3(32.0-51.3)	65.9(56.5-74.3)	2.75(1.56-4.85)	<0.001	2.77(1.71-4.46)	<0.001
Problems Getting Transportation	15.8(10.4-23.2)	16.9(9.8-27.6)	1.09(0.49-2.39)	0.84	0.82(0.43-1.59)	0.56
Problems with Cost of Care	51.6(40.9-61.2)	46.4(36.9-56.1)	0.81(0.45-1.45)	0.48	0.75(0.46-1.22)	0.25
Service Was Unavailable	32.9(24.6-42.4)	38.4(28.9-48.9)	1.28(0.71-2.30)	0.42	1.13(0.68-1.88)	0.64
Office Was Not Open	12.6(8.3-18.9)	37.7(28.3-48.1)	4.18(2.21-7.90)	<0.001	4.58(2.46-8.52)	0.85

Adjusted odds ratios adjust for child sex, age, race, insurance continuity and type, presences of an emotional, behavioral, or developmental problem, complexity of needs, parent education, family structure, language and household income.

Discussion

In response to the COVID-19 pandemic, policymakers implemented a wide range of policies intended to prevent care disruptions for vulnerable populations including CYSHCN. This evaluation of the utilization of preventive care and access to care from 2019 to 2020 examines the initial impact of COVID-19 pandemic on CYSHCN. While CYSHCN were largely shielded from significant impacts during this time, we found important changes in utilization of and access to care as well as barriers to care that should inform future policy interventions.

In the first year of the pandemic, CYSHCN had a statistically significant decrease in preventative dental visits and increased unmet mental health care needs. Notably, these trends were consistent with trends in the general pediatric population, not unique to CYSHCN (Lebrun-Harris et al., 2022). As such, we believe that the policies implemented to support CYSHCN generally achieved their goal of mitigating the effect of the COVID-19 pandemic on utilization of and access to care. Further, given the vulnerability of CYSHCN to care disruptions, we believe these findings are reassuring that the identified declines in utilization and access are not a unique challenge for CYSHCN but reflect challenges to providing adequate health care to all children in the United States.

Within the population of CYSHCN we found disparities in utilization of and access to care among key subgroups. The disparities identified were not novel findings but are consistent with widely known pre-pandemic barriers to care for CYSHCN (Cheak-Zamora & Thullen, 2017; Glassgow & Van Voorhees, 2017; Rosen-Reynoso et al., 2016; Vish & Stolfi, 2020). As policymakers consider future interventions to ensure care for CYSHCN, targeted strategies to support key subpopulations can help close service gaps. Specifically, as CYSHCN age their use of preventative care decreases and expansion of evidence-based programs including school-based health care and nonclinical services (i.e., language services, transportation) are strategies to apportion care to these children (Arenson et al., 2019; Yue et al., 2019). Additionally, CYSHCN with ongoing emotional, behavioral or developmental problem and greater complexity had greater unmet care needs. While opportunities to address improved access for this population exists through expansion of targeted Medicaid Home and Community-Based Services waivers and changes in financial reimbursement structures that account for complexity of care, future work should examine which strategies are most effective in facilitating CYSHCNs’ access to needed care.

Importantly, the pandemic highlighted systemic disparities in health care access and outcomes in the United States (Centers for Disease Control and Prevention, 2021; Lopez, Hart & Katz, 2021). While we were only able to look at differences among subpopulations in utilization of and access to care, as more years of data are available, analysis of clinical and demographic variation in changes in services access and utilization will be vital for assessing the differential impacts of the COVID-19 pandemic on these key subgroups. Specifically, we anticipate that the pandemic had an unequal impact on minority and lower income populations of CYSHCN, as well as CYSHCN with emotional, behavioral, or developmental conditions. Enumerating disparities will be important to highlight to justify the need for policy, system, or practice changes that may address any observed disparities.

We identified important changes in barriers to care among CYSHCN who had unmet health care needs. Ineligibility for services declined significantly from 2019 to 2020 and may be the direct result of numerous pandemic related policies (Table 1) to support CYSHCN. Continuing these policies beyond the end of the public health emergency may be a mechanism to sustain gains in access to care for CYSHCN. However, children who had coverage gaps had greater unmet health care and specialty care needs; additional exploration of barriers in this group can inform further policy changes and health system interventions aimed at preventing coverage interruptions.

Inability to obtain an appointment was the only barrier that became more pronounced from 2019 to 2020. This may be the result of the initial response to the pandemic with lockdown policies that closed offices and led to a transition period with wider implementation of telehealth (Levey, 2021). Evaluation of the persistence in reports of an inability to obtain should be a future priority to assess the long-term impact of the COVID-19 pandemic on access to care.

Limitations

This study has several limitations. First, the data do not allow causal inference of the effect of the COVID-19 pandemic on CYSHCN utilization of and access to care. Data was collected for the 2020 NSCH from June 2020 to January 2021. As a result, the 2020 survey is unlikely to capture the full effect of the pandemic on utilization and access to care. However, there is some indication that changes in pediatric health care may be limited to the beginning of the pandemic (Scheweiberger et al., 2021). As such, future research should include future years of data to evaluate persistence of pandemic patterns. In addition, the NSCH collects self-reported data introducing the possibility of recall bias and inaccuracy in report. Specifically, the determination of what constitutes an unmet need may differ among families and health care providers and is a limitation of this data.

Conclusions

While CYSHCN had declines in preventive dental visits and increased unmet mental health care needs, novel health policies adopted in response to the COVID-19 pandemic may have mitigated negative impacts for this vulnerable population. In fact, CYSHCN with unmet health care needs saw improvements in their eligibility for care. Future work should examine how the COVID-19 pandemic influenced disparities in utilization of and access to care among subgroups of CYSHCN including minorities, those from low-income families, and those with emotional, behavioral, or developmental problems.

Ethics Statement

All authors meet the standards for authorship. This article is a secondary data analysis of publicly available data and no IRB approval was required to complete this manuscript.

Uncited References

Howard-Jones et al., 2022