injury prevention web logo
IPW Home

Safety Policy
Home Page

IPW Info:

Injury Prevention Links

Injury Prevention Books

Publications Available
On-Line from IPW Sites

Other IPW Sites

Visit our partner in this policy project:

Policy Matters logo
Policy Matters



Medicaid Funded Child Restraints


Motor vehicle traffic crashes are the leading cause of unintentional injury-related death for children ages 4 and under. In 1997, 483 children 4 and under died as occupants in motor vehicle crashes (1). Unrestrained children are more likely to be injured, have more severe injuries, and to die in motor vehicle crashes than children who are restrained.

Several studies have found that children of families receiving Medicaid do not travel safety in motor vehicles. One study found that 68.5% of 0-3 year-olds receiving Medicaid services in Memphis, Tennessee travel in automobiles without adequate protection (2). The authors of another suggest that about 60% of children ages 0-4 on Medicaid travel unrestrained while only 10-15% of other children travel unrestrained (3). Other researchers reported that for those respondents in their study who did not have a car seat, cost was cited as the most frequent reason (71%) for not having one (4).

Policy and Details

1. Medicaid programs will support the cost of size-appropriate restraints for children of eligible families and the hands-on training necessary to use the restraints correctly.

The Health Care Finance Administration should allow federal Medicaid reimbursement for infant and child safety seats as durable medical goods. Low-income families should not be put at additional risk for lifelong disabilities or even death simply because they may not be able to afford reliable safety seats for their families. Medicaid coverage of child restraints may also alleviate the problem of unsafe second hand car seats being resold.

Many states are not able to provide comprehensive, statewide child safety seat programs and training due to lack of adequate resources. State programs with funds allocated specifically towards the provision of car seats could reallocate these resources toward additional child safety seat programs and training if federal Medicaid reimbursement for child restraint systems and training in their use were mandated.

The American Academy of Pediatrics, the American Public Health Association, the Association of State and Territorial Health Officers, and the State and Territorial Injury Prevention Directors' Association have passed resolutions which encourage Medicaid to include child restraint systems as a benefit of coverage (5, 6, 7, 8).


Child safety seats are extremely effective when correctly installed and used in passenger cars. Research on the effectiveness of child safety seats has found that they reduce the risk of fatal injury by 69 percent for infants (less than 1 year old) and by 47 percent for toddlers (1-4 years old) (9). If all child passengers ages 5 and under were properly restrained, it is estimated that an additional 183 lives could have been saved in 1997 alone (10).

Over a four-year average, a $50 safety seat for a child on Medicaid can save almost $100 in medical costs and $1,400 in preserved good health (11). Medicaid could experience net cost savings by averting expensive medical costs with support for the purchase of safety seats and training to use them properly.

South Carolina includes child passenger safety (CPS) education as part of its Medicaid program entitled Family Support Services. The need for CPS education is determined through a client assessment. CPS is included in the Family Support Services program because it is viewed as an environmental risk factor that may negatively impact the health status of the recipient.


1. Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC. 1997, United States MV traffic, Occupant Deaths and Rates per 100,000. Available online:, April 11, 2000.

2. Sharp GB, Carter MA. Use of Restraint Devices to Prevent Collision Injuries and Deaths Among Welfare-Supported Children. Public Health Reports, 107 (1): 116-18, 1992.

3. Miller T, Demes J, and Bovbjerg, R. Child Seats: How Large Are the Benefits and Who Should Pay?, Child Occupant Protection, SP-986, Proceedings of the AAAM-STAPP-ICROBI Child Occupant Protection Sessions, Warrendale, PA: Society for Automotive Engineering, November, 1993.

4. Radius SM, McDonald EM, Bernstein L. Influencing Car Safety Seat Use: Prenatal and Postnatal Predictors. Health Values, 15 (4): 29-38, 1991.

5. American Academy of Pediatrics. Safe Transportation of Newborns at Hospital Discharge (RE9854). Pediatrics, 104 (4): 986-987, 1999. Available online:, April 4, 2000.

6. American Public Health Association. 9307: Health Insurance Coverage for Child Safety Interventions. American Journal of Public Health, 84 (3): 515-6, 1994.

7. Association of State and Territorial Health Officers, Executive Committee. Recommendations from the Injury Prevention Task Force and ASTHO Prevention Policy Committee. ASTHO Report 7(19), p. 5, 1999.

8. The State and Territorial Injury Prevention Directors' Association. Child Safety Seat Availability and Training. Available online:, February 21, 2000.

9. National Highway Traffic Safety Administration. Traffic Safety Facts 1997: Children. DOT HS 808 765.

10. National Highway Traffic Safety Administration. Traffic Safety Facts 1997: Occupant Protection. DOT HS 808 768.

11. Miller, T and Levy, D. Cost-Outcome Analysis in Injury Prevention and Control: 84 Recent Estimates for the United States. Medical Care, 38(6):562-582, 2000.

Back to Policy Menu

Last modified: 4-August-2002.