Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Special Education

First Advisor

Dr. Kevin Sutherland


The purpose of this study was to explore factors that impact children with special healthcare needs’ (CSHCN) health insurance coverage and out-of-pocket medical expenses. The Ecological Model for Health Promotion developed by McLeroy et al. (1988) was the guiding theoretical framework for this study. Using data from the 2020 National Survey of Children’s Health, I conducted descriptive statistics, logistic regressions, and multilevel modeling analyses to determine if health insurance coverage and out-of-pocket expenses for CSHCN differed by individual, family, and community, organization, and policy factors. Results indicated that race, gender, disorder category, insurance type, and family’s federal poverty level were associated with CSHCN’s type of health insurance, insurance coverage, problems paying for medical bills, and out-of-pocket medical expenses. Implications for research and policy, along with limitations for this study, are reported.


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Date of Submission