In the United States, caring for a child with special health care needs usually means higher medical expenses for a family — particularly for low-income families, who spend a disproportionally large share of their income on their child's care. Yet for individual families, the impact of out-of-pocket costs is often a function of their state of residence, says Paul T. Shattuck, Ph.D., professor of social work at Washington University in St. Louis. "The percentage of low-income families in a given state with out-of-pocket expenses that exceeded 3 percent of their income varied considerably according to state and ranged from 5 percent to 25. 8 percent (District of Columbia and Montana, respectively)," he says.
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