Key Issues in Children’s Health Coverage

Key Issues in Children’s Health Coverage

Following decades of progress, bolstered by the ACA, the children’s uninsured rate has reached an all-time low. This brief reviews children’s coverage today and examines what is at stake for children’s coverage in upcoming debates around CHIP funding, repeal and replacement of the ACA, and restructuring of Medicaid financing to a block grant or per capita cap.

Coverage for Children Today

The uninsured rate among children has reached an all-time low of 5%.

The uninsured rate among children has steadily decreased over time, with additional declines since implementation of the ACA in 2014. These coverage gains have stemmed from new coverage options for children through expansions of Medicaid and CHIP and the ACA Marketplaces and subsidies as well as from streamlining of enrollment and renewal processes and focused outreach and enrollment efforts. Children have had much larger gains in coverage than adults over the last two decades, largely reflecting the broader availability of Medicaid and CHIP coverage for children compared to adults.

Medicaid and CHIP are key sources of coverage for our nation’s children.

Today, over half of children are covered through private insurance, including parents’ employer-sponsored plans and individual market plans. Medicaid and CHIP cover nearly four in ten (39%) children overall and play a larger role for children with low incomes and special health needs.

Together, the programs cover two-thirds (66%) of children in low-income families (below 200% of the federal poverty level, FPL) and more than three-quarters (76%) of children in poor families (below 100% FPL). Moreover, the programs cover more than four in ten (44%) of children with special health care needs. Despite consistent coverage gains over time, 5% or about 4 million children remain uninsured. Children’s uninsured rates range across states from a 2% in Illinois to 13% in Arizona. Most uninsured children are eligible for Medicaid and CHIP, but not enrolled.

Health coverage provides children access to needed care and promotes improved health, education, and financial success over the long-term.

Children with health coverage fare better on measures of access to care compared to uninsured children, and access for children with Medicaid and CHIP is comparable to access for children with private coverage along these measures. Studies also show that medicaid and chip health insurance in pa contribute to long-term positive outcomes in health, school performance and educational attainment, and economic success. Moreover, parents say they are thankful for Medicaid and CHIP and have peace of mind knowing their children are covered. Polling data show that most adults (88%) would enroll a child in Medicaid if the child was eligible.

The Role of Medicaid and CHIP for Children

All states have expanded eligibility for children through Medicaid and CHIP.

Medicaid is the base of coverage for our nation’s low-income children. CHIP complements Medicaid by covering uninsured children in families with incomes above Medicaid eligibility levels. States provide CHIP by creating a separate CHIP program, expanding Medicaid, or adopting a combination approach. The ACA built on previous Medicaid expansions for children by establishing a minimum Medicaid eligibility level of 138% FPL for children of all ages.

Prior to the ACA, this minimum was already in place for children below age 6, but the minimum for children ages 6 to 18 was 100% FPL. As a result of this change, 19 states transitioned coverage for older children from separate CHIP programs to Medicaid. All states have expanded children’s eligibility beyond the minimum through Medicaid and CHIP. As of January 2017, 49 states extend Medicaid/CHIP eligibility for children up to at least 200% FPL .