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Children with 4 or more acute care visits consisted of only 4% of the cohort but accounted for 15% (US $4.7 billion) of the total spending. Increasing acute care visits were associated with increasing total annualized spending in adjusted analyses (P less then 0.001). This association was disproportionately observed in older age groups and children without chronic medical conditions. Conclusions Medicaid spending for children increases with increasing acute care use; this trend was disproportionately observed in older age groups and childr