Inside CMS

By Erin Rafferty

October 29th, 2015

The rate of uninsured children dropped to an historic low of 6 percent in 2014, down from 7.1 percent in 2013, and states that expanded Medicaid typically had sharper declines in the number of uninsured children than non-expansion states, according to a report commissioned by the Georgetown Center for Children and Families. The report credits the Affordable Care Act for the improved coverage.

The “maintenance of effort” ACA provision, which requires states to maintain until September 2019 eligibility levels for children’s coverage in Medicaid and the Children’s Health Insurance Program, is one likely reason that the rate of uninsured children decreased, according to the report.

The ACA required that in 2014 states expand Medicaid to children of families with incomes up to 138 percent of the federal poverty level. Some states already covered children at that level in their Children’s Health Insurance Programs so they had to move children from CHIP to Medicaid, according to the report. The transition from CHIP to Medicaid meant low-income families in seven states no longer had to pay premiums to enroll their children. Imposing premiums on low-income families has been shown to suppress enrollment, and the report states the transition from CHIP to Medicaid contributed to the decreased rate of uninsured children.

Under the Affordable Care Act, states that implement the Medicaid expansion receive 100 percent federal match for those made eligible by the expansion. The report said that expansion states likely saw a decrease in uninsured children because of a “welcome mat” effect when parents enrolled their children when they signed up for newly available coverage through the ACA, and that non-expansion states appeared to have a “welcome mat” effect as well. The report said that prior research has shown that covering parents increases the rate of coverage for their children as well.

Expansion states had lower rates of uninsured children before expansion, but there still was a sharper rate of decline in uninsured children in expansion states than in non-expansion states. There was a 21.7 percent decline in expansion states and only a 11.6 percent decline in non-expansion states.