Barriers to Genetic Testing for Pediatric Medicaid Beneficiaries with Epilepsy

Publication date: Available online 20 April 2017
Source:Pediatric Neurology
Author(s): Eric J. Kutscher, Sucheta Joshi, Anup D. Patel, Baria Hafeez, Zachary M. Grinspan
ObjectiveChildren with public insurance (Medicaid) have increased barriers to specialty care in the United States. For children with epilepsy, the relationship between public insurance and barriers to genetic testing is understudied.MethodsWe surveyed a sample of US child neurology clinicians. We performed quantitative and qualitative analysis of responses.ResultsThere were 302 responses (of 1982 surveyed; response rate 15%) from clinicians from 46 states, the District of Columbia, and Puerto Rico, including board-certified child neurologists (82%), resident physicians (6%), nurses (3%), and nurse practitioners (3%). More clinicians felt it was more difficult to get genetic testing for patients with Medicaid insurance compared to commercial insurance, (43% vs. 12%, p<0.05), though many felt it was about the same degree of difficulty (25%) or were not sure (20%). Increased availability of testing was associated with less complex testing (p<0.001), in-house testing (p<0.001), and no pre-authorization requirements (p<0.001). Qualitative responses described barriers related to cost, clinician familiarity and comfort, commercial laboratories, healthcare organization, payer, and patient concerns. Descriptions of facilitators included lowered cost, availability of clinical genetics expertise, clinician knowledge, commercial laboratory assistance, healthcare organizational changes, improved payer coverage, and increased interest by parents.Significance.Pediatric Medicaid beneficiaries with epilepsy have barriers to genetic testing, compared to children with commercial insurance, particularly for more advanced testing. Potential strategies to improve access include broader coverage, lower co-pays, increased capacity for testing outside of specialty labs, fewer pre-authorization requirements, improved clinician education, ongoing development and dissemination of guidelines, improved availability of clinical genetics services, and continued assistance programs from commercial laboratories.



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