Inpatient Medicaid Utilization at Select Children's Hospitals
RAND Health Quarterly, 2025; 13(1):5
RAND Health Quarterly is an online-only journal dedicated to showcasing the breadth of health research and policy analysis conducted RAND-wide.
More in this issueAbstract
Medicaid and the Children's Health Insurance Program together provide health insurance for 78.6 million low-income Americans, including 37.3 million children. This study describes inpatient utilization at select U.S. children's hospitals by Medicaid-insured patients. Legislation passed in July 2025 changed Medicaid eligibility requirements. For this study, RAND researchers processed hospital cost report data for policymakers to analyze.
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Medicaid and the Children's Health Insurance Program (CHIP) together provide health insurance for 78.6 million low-income Americans, including 37.3 million children (Centers for Medicare and Medicaid Services, 2025b). Legislation passed in July 2025 changed Medicaid eligibility requirements, and the potential impact of these changes on children's hospitals across the United States is not well understood (House of Representatives, 2025). Although there is no national dataset that reliably reports Medicaid-specific information for each children's hospital in the United States, all U.S. hospitals that provide care to patients enrolled in Medicare are required to submit an annual cost report to the Centers for Medicare and Medicaid Services (CMS). For this study, I use these cost report data, cleaned and processed by the RAND Hospital Data team, to describe inpatient utilization by Medicaid-covered patients at select children's hospitals.1 I do not describe how potential changes in Medicaid eligibility would directly or indirectly impact these hospitals. These data have been processed for policymakers to analyze.2
Key Findings
- The share of discharges paid for by Medicaid varies widely across children's hospitals, with a mean of 47.2 percent. In addition, 38 hospitals (51.4 percent) across 20 states reported that Medicaid paid for more than 50 percent of their inpatient discharges.
- The share of inpatient days paid for by Medicaid also varies, with a mean of 52.2 percent; 46 hospitals (62.2 percent) across 22 states reported that Medicaid paid for more than 50 percent of their inpatient days.
Methods
This analysis merges the May 2025 releases of two datasets: the Hospital Enrollments file from CMS and RAND Hospital Data, a compilation of hospital cost report data from 1996 to the present (Centers for Medicare and Medicaid Services, 2025a; White, 2018). Hospitals are included in the analysis if they (1) self-reported providing services to children in the Hospital Enrollments file; (2) provided sufficient services to children covered by Medicare to require the filing of a cost report; and (3) completed the cost report fields needed to calculate two selected metrics of utilization.
Those two metrics of utilization are
- the Medicaid inpatient discharge share (i.e., the percentage of all patients released from the inpatient setting whose stays were paid for by Medicaid)3
- the Medicaid inpatient day share (i.e., the percentage of the cumulative number of days spent in the hospital by all discharged patients whose stays were paid for by Medicaid).
All data analysis was conducted using Stata statistical software (StataCorp, 2023).
Results
A total of 106 hospitals indicated that they provide services to children in the Hospital Enrollments file. Of these, 74 children's hospitals reported sufficient data to calculate the two selected metrics in either federal fiscal year (FFY) 2023 or FFY 2024 (see Table 1). For hospitals reporting data in both years, I used FFY 2024 data; 62 hospitals (83.7 percent) had FFY 2023 data, and 12 hospitals (16.2 percent) had FFY 2024 data. Data are available from at least one hospital in each of 30 states plus the District of Columbia. These data indicate that the share of discharges paid for by Medicaid varies widely across children's hospitals, with a mean of 47.2 percent (median: 50.3 percent, IQR: 35.5 percent to 58.7 percent).4 In addition, 38 hospitals (51.4 percent) across 20 states reported that Medicaid paid for more than 50 percent of their inpatient discharges. The share of inpatient days paid for by Medicaid also varies, with a mean of 52.2 percent (median: 55.0 percent, IQR: 40.9 percent to 63.9 percent); 46 hospitals (62.2 percent) across 22 states reported that Medicaid paid for more than 50 percent of their inpatient days.
Key Limitations
There are important limitations to the data presented in this article. First, hospitals are required to file cost reports only if they provide care to Medicare patients in a given fiscal year, and low-volume Medicare hospitals are required to report only limited data. As a result, these data are missing a large fraction of children's hospitals. For example, the Children's Hospital Association reports representing more than 200 member hospitals, compared with the 74 hospitals identified in this analysis (Children's Hospital Association, undated).
Second, children's hospital status in the data is identified by self-report; some hospitals in the sample might not be considered children's hospitals by other definitions. Relatedly, hospitals represented in these data include both freestanding children's hospitals and general hospitals with a pediatric department or unit.
Third, it is possible that some hospitals misreported key values. I attempted to validate these data by spot-checking the cost reports against public information, such as information on hospitals' websites. Although many of the numbers appeared to be consistent, I found some discrepancies. My analysis presents the information from the cost reports without further adjustment, even in cases in which I could not reconcile the cost reports with other public information.
Last, hospitals are allowed to submit cost reports using their own fiscal year; presented data are not adjusted to a standardized time period for comparisons across hospitals.
Funding for this research was provided by gifts from RAND supporters and income from operations. This research was carried out within RAND Health Care.
More in this issueNotes
- The term inpatient utilization refers to hospitalizations that require at least one overnight stay. ⤴
- RAND is a nonpartisan research organization that does not take positions on legislation. This article should not be construed as an endorsement for or against any legislation. ⤴
- These two shares include both fee-for-service Medicaid and Medicaid managed care/health maintenance organization (HMO). The figures used in Table 1 reflect this information. ⤴
- IQR is the interquartile range, which is a measure of the spread of the middle 50 percent of data. It is calculated by dividing the reported data into quartiles and finding the values that match the 25th and 75th percentiles. ⤴
References
- Centers for Medicare and Medicaid Services, dataset, Hospital Enrollments, May 2025a.⤴
- Centers for Medicare and Medicaid Services, March 2025: Medicaid and CHIP Eligibility Operations and Enrollment Snapshot, June 27, 2025b.⤴
- Children's Hospital Association, Find a Hospital: Hospital Directory, undated.
- House of Representatives, One Big, Beautiful Bill Act, Bill 1, July 3, 2025.⤴
- StataCorp, Stata Statistical Software, Release 18, 2023.⤴
- White, Chapin, RAND Hospital Data: Web-Based Tool, RAND Corporation, TL-303, 2018. As of November 6, 2025:
https://www.rand.org/pubs/tools/TL303.html⤴
