Medicaid and Child Health Insurance Program Improve Child Health and Reduce Poverty But Face Threats

Abstract

Over the past 20 years, the United States greatly expanded eligibility for public health insurance under the Medicaid and Child Health Insurance Program programs. This expansion improved children's access to health care and their health, ultimately lowering preventable hospitalizations, chronic conditions, and mortality rates in the most vulnerable children at a cost that is 4 times lower than the average per capita cost for the elderly. They also had broader antipoverty effects, increasing economic security, children's educational attainments, and their eventual employment and earnings opportunities. However, in recent years, this progress has been rolled back in many states. Remarkably, although income eligibility cutoffs have remained largely constant, states have reduced child coverage through a number of administrative measures ranging from increased paperwork, to reduced outreach, new parental work requirements, changes to public charge rules for immigrants, and waivers of federal requirements to provide retroactive coverage to new applicants. The number of uninsured children was rising for the first time in decades even prior to the pandemic. With rising numbers who have lost their jobs in the pandemic-induced recession, it is more important than ever to defend and restore and improve access to public health insurance for our children.

Keywords: Medicaid; children; coronavirus 2019; poverty; public health insurance access.

Figure 1.

CHIP and Medicaid median income eligibility thresholds by eligibility category as a percentage of the Federal Poverty Line, 2000 to 2020. Notes: Data are from the Kaiser Family Foundation’s State Health Facts and are derived from a national survey conducted by the Kaiser Program on Medicaid and the Uninsured with the Center on Budget and Policy Priorities, 2000 to 2009; and with the Georgetown University Center for Children and Families, 2011 to 2020. Available at: https://www.kff.org/medicaid/report/annual-updates-on-eligibility-rules-enrollment-and-renewal-procedures-and-cost-sharing-practices-in-medicaid-and-chip/. CHIP indicates Child Health Insurance Program.

Figure 2.

Child Medicaid and CHIP enrollments and percent of children who are uninsured. Notes: Child Medicaid enrollments come from MACStats Medicaid and CHIP data book, December 2019, Exhibit 7, https://www.macpac.gov/publication/medicaid-beneficiaries-persons-served-by-eligibility-group/. Children who qualified by reason of disability are not included in these totals. Data are missing for 2014 and 2015 because of a change in data systems. CHIP enrollment data come from the Kaiser Family Foundations State Health Facts, “Total Number of Children Ever Enrolled in CHIP Annually,” https://www.kff.org/other/state-indicator/annual-chip-enrollment. The percent uninsured are based on the author’s calculations. For 2008 to 2019, data are from the US Census’ American Community Surveys https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html and refers to children less than 19. For 2000 to 2007, the data are from the US Census Bureau, Current Population Survey, Annual Social and Economic Supplements. 2000 to 2007. https://www.census.gov/data/tables/time-series/demo/health-insurance/historical-series/hia.html, and refers to children less than 18. CHIP indicates Child Health Insurance Program.

Figure 3.

Trends in child Medicaid and CHIP enrollments in 4 states. Notes: Based on the same data as Table 2. The x-axis is expanded for January to June 2020 to show trends in the first months of the pandemic in greater detail. Dashed lines show income eligibility cutoffs as percent of the Federal Poverty Level. CHIP indicates Child Health Insurance Program.