Below is an updated description of sources used for data reported on the State and National Snapshots provided by Georgetown University Center for Children and Families (CCF) and the American Academy of Pediatrics (AAP). All snapshots are available here.

Children’s Uninsurance Rates (2008-2015) and Sources of Children’s Coverage (2015)               

Georgetown CCF analysis of single-year estimates of summary data from the 2008-2015 American Community Survey (ACS). Children are defined as those under the age of 18. Data on sources of health insurance coverage convey whether a person has coverage at the time of the survey. The ACS is administered throughout the calendar year.

The Census Bureau provides the following categories of coverage for respondents to indicate source of health insurance: current or former employer, purchased directly from an insurance company, Medicare, Medicaid or means-tested (includes CHIP), TRICARE or other military health coverage, VA, Indian Health Service (IHS), or other. People who indicate IHS as their only source of health coverage do not have comprehensive coverage and are considered to be uninsured. The estimates are not adjusted to address the Medicaid undercount often found in surveys. Individuals can report more than one source of coverage.

In the “other” source of health coverage, we report children covered by Medicare, TRICARE/military, VA, or two or more types of health insurance.

Additional information on methodology is provided in CCF’s annual report on children’s coverage rates.

• J. Alker and A. Chester, Children’s Health Coverage Rate Now at Historic High of 95 Percent, Georgetown University Center for Children and Families (October 2016).

Number of Children Enrolled in Medicaid/CHIP

Medicaid and CHIP enrollment data are reported from CMS. The data represent the unduplicated number of children ever enrolled in Medicaid or CHIP for FY 2016.

• Centers for Medicare & Medicaid Services (CMS), “Unduplicated Number of Children Ever Enrolled“, (February 2017).

Percent of Medicaid/CHIP Enrollees that are Children     

Georgetown CCF analysis of monthly November 2016 CMS Medicaid & CHIP Enrollment reports for 48 states. States report data for each calendar month. Coverage is a point-in-time estimate of unduplicated number of children enrolled in Medicaid/CHIP who are receiving comprehensive benefits. Child is defined on a state-by-state basis. CHIP covers pregnant women in some states so there may be some adults included in the total number of enrollees. Numbers are rounded to the nearest thousand.

Monthly enrollment data is preliminary and may be updated in subsequent CMS Eligibility and Enrollment Reports. Additional information about methodology, including state-by-state table notes, are available here: November 2016 Medicaid and CHIP Enrollment Data Highlights.

• Centers for Medicare & Medicaid Services (CMS), November 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report, (January 2017).

Forty-eight states reported monthly enrollment data in November. There were three states (Arizona, District of Columbia, and Tennessee) with no data available. Tennessee’s enrollment numbers are from email communication with the TennCare Division of Health Care Finance & Administration based on December 2016 point-in-time enrollment. We report data for Arizona and the District of Columbia (percent of child beneficiaries) using Medicaid and CHIP Payment and Access Commission (MACPAC) analysis of MSIS data of Medicaid full-year equivalent enrollment by state and eligibility group for fiscal year 2013. Numbers are rounded to the nearest thousand. Full-year equivalent is unduplicated, average monthly enrollment in Medicaid. Children are those who qualify for Medicaid based on age (rather than disability) and includes full benefit enrollees. Children enrolled in CHIP-financed coverage are excluded.

Additional information about data analysis and collection by MACPAC is provided in the Technical Guide to MACStats.

• Medicaid and CHIP Payment and Access Commission (MACPAC), Exhibit 15: Medicaid Full-Year Equivalent Enrollment by State and Eligibility Group, FY2013 (thousands), December 2016 edition of MACStats: Medicaid and CHIP Data Book (as of December 2015).

Children’s Marketplace Enrollment 

Georgetown CCF analysis of enrollment-related information for the Health Insurance Marketplaces during the 2016 Open Enrollment period (November 1, 2015 through January 31, 2016, including Special Enrollment Period activity through February 1, 2016). ASPE provides the percent of total marketplace enrollees under age 18. Number of enrolled children is an estimate and rounded to nearest thousand.

• HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), Addendum to the Health Insurance Marketplace 2016 Open Enrollment Period: Final Enrollment Report, U.S. Department of Health and Human Services (March 2016).

Low-Income Children with Medicaid/CHIP

Georgetown CCF analysis of single-year estimates of summary data from the 2015 American Community Survey (ACS). Children are defined as those under the age of 18. Data on sources of health insurance coverage are point-in-time estimates that convey whether a person has coverage at the time of the survey.

Low-income is defined as children under 138 percent of the poverty threshold ($27,821 for a family of three in 2016). Data on poverty levels include only those individuals for whom the poverty status can be determined for the last year. The Census determines an individual’s poverty status by comparing that person’s income in the last 12 months to poverty thresholds that account for family size and composition, as well as various types of income. Coverage includes children with Medicaid/CHIP alone and excludes children with Medicaid/CHIP in combination with another health coverage source.

Additional information on methodology is provided in CCF’s annual report on children’s coverage rates.

• J. Alker and A. Chester, Children’s Health Coverage Rate Now at Historic High of 95 Percent, Georgetown University Center for Children and Families (October 2016).

Young Children with Medicaid/CHIP

Georgetown CCF analysis of single-year estimates of summary data from the 2015 American Community Survey (ACS). Young is defined as children under six years old. Coverage includes children with Medicaid/CHIP alone or in combination with another health coverage source.

Additional information on methodology is provided in CCF’s annual report on children’s coverage rates.

• J. Alker and A. Chester, Children’s Health Coverage Rate Now at Historic High of 95 Percent, Georgetown University Center for Children and Families (October 2016).

Children with Special Health Care Needs with Public Coverage       

Georgetown CCF analysis of summary data from the 2011/12 National Survey of Children’s Health. Public health insurance coverage includes Medicaid and CHIP.

The National Survey of Children’s Health defines children with special health care needs (CSHCN) using a screener and definition created by the Maternal and Child Health Bureau. The CSHCN Screener asks whether a child has a medical, behavioral, or other health condition and, if so, whether that health condition has lasted or is expected to last for 12 months or longer. Additional detail about the methodology is provided by the Data Resource Center for Child & Adolescent Health.

• Data Resource Center for Child & Adolescent Health, What type of health insurance coverage, if any, did [child name] have at the time of the survey? 2011/12 National Survey of Children’s Health (accessed February 2017).

Children in Foster Care with Medicaid/CHIP                

Urban Institute analysis of Medicaid Statistical Information System (MSIS) data. In 2001, states provided Medicaid coverage to approximately 870,000 foster care children for $3.8 billion. “All foster children for whom states receive federal reimbursement for foster care expenses (under title IV-E of the Social Security Act) are categorically eligible for Medicaid. States have the option to extend Medicaid benefits to non-IV-E eligible foster children, and all states do. In addition, children receiving federally reimbursed adoption subsidies are categorically eligible for Medicaid. All states but one have also chosen to cover adopted children supported by state-funded subsidies in their Medicaid programs. Thus, virtually all children in foster care and in adoptive placements are eligible for Medicaid.”

• Green, A Sommers, M. Cohen, Medicaid Spending on Foster Children, The Urban Institute (August 2005).

Births Financed by Medicaid

For 50 states (including D.C.), the percent of newborns in low-income families with Medicaid/CHIP is provided by the 2016 Kaiser Family Foundation Medicaid Budget Survey, which asked states to report the share of births financed by Medicaid in the most recent 12-month period for which data were available. States reported data for different years that ranged from 2010-2016. Additional information about the methodology is provided in Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017.

• Kaiser Family Foundation, Births Financed by Medicaid, State Health Facts (October 2016).

For Hawaii and the United States, data on percent of births financed by Medicaid is provided by a study done by the Jacobs Institute of Women’s Health at the George Washington University and March of Dimes. States reported data for 2010.

• Markus, et al., Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform, Women’s Health Issues 23 no. 5 (2013), pg. 273-280.

Name of CHIP Program              

• Kaiser Family Foundation, CHIP Program Name and Type, State Health Facts (as of May 1, 2015).

Medicaid as Percent of Federal Funding        

• Kaiser Family Foundation analysis of National Association of State Budget Officers (NASBO), State Expenditure Report: Fiscal 2014-2016, November 17, 2016. DC estimates for the share of state general fund spending and the share of federal funds for Medicaid are from KFF communication with the DC Fiscal Policy Institute.

EPSDT Services

• Section 1905(r)(1)(B) of the Social Security Act. For a full description of EPSDT coverage, see Department of Health and Human Services, EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents, June 2014.
• Georgetown University Center for Children and Families, EPSDT: A Primer, Georgetown University Center for Children and Families (March 2016).

Average Cost Per Child Enrolled in Medicaid

Estimated per enrollee spending in 2015 for children ($3,389), non-newly eligible adults ($4,986), and newly eligible adults ($6,365) was much lower than that for aged enrollees ($14,323) and enrollees with disabilities ($19,478), resulting in an overall average of $7,492 per enrollee in 2015. The percent of total Medicaid enrollees represented by children is a person-year equivalent, which is different, from the point-in-time enrollment reported from the CMS Medicaid and CHIP Enrollment Reports. Person-year equivalent can be lower than point-in-time enrollment if individuals are not enrolled for a full year.

• Truffer, C. Wolfe, and K. Rennie, 2016 Actuarial Report on the Financial Outlook for Medicaid, Office of the Actuary, Centers for Medicare & Medicaid Services, and the Department of Health & Human Services (January 2017).

Long-Term Benefits of Medicaid for Children

• Chester and J. Alker, Medicaid at 50: A Look at the Long-Term Benefits of Childhood Medicaid, Georgetown Center for Children and Families (July 2015).