Continuing our deeper dive into recent coverage gains among at-risk populations thanks largely to Medicaid (like our recent report on Medicaid’s disproportionate role for small towns and rural areas), today we are releasing a new paper “Coverage Trends for American Indian and Alaska Native Children and Families.”

The big takeaway: Uninsured rates for AI/AN children and adults have declined significantly, but they are still too high. And they are likely to go up if substantial Medicaid cuts are enacted by Congress.

The report uses American Community Survey (ACS) data to examine Medicaid enrollment and uninsured rates for children and non-elderly adults (19-64) from the period 2008 to 2015. The report uses racial categories established by the U.S. Census Bureau and examines trends for persons who indicated that they were American Indian or Alaska Native (AI/AN) only. We looked at the national trend and trends in a sub-set of states where this is a significant population–either in terms of proportion of their Medicaid population or in absolute numbers (over 10,000).

Here are some of the key findings:

• Children in AI/AN families are much more likely to rely on Medicaid than all children. Nationally 54% of AI/AN children receive their health services through Medicaid as compared to 39% of all children.
• Nationally the uninsured rate for AI/AN children declined from 25% to 15% between 2008 to 2015. All of the states with very high proportions of their AI/AN children on Medicaid saw very large double-digit declines. The two states with the largest declines in their uninsured rate for kids were New Mexico (38% to 11%) and Alaska (32% to 17%).
• Nationally the uninsured rate for AI/AN adults declined from 36% to 28%. States that expanded Medicaid to adults under the Affordable Care Act (ACA) saw the largest declines.
• States for whom Medicaid is the most important for AI/AN children (in order of importance) are Alaska, South Dakota, North Dakota, Montana, New Mexico, Arizona and Oklahoma.

As readers of SayAhh! well know, the uninsured rate for both children and adults has been coming down–for children this has been a longer trend thanks to Medicaid and CHIP. The ACA accelerated this progress and also offered coverage to many parents and other adults.

At a time when Congress is considering extremely large cuts to Medicaid and a dangerous restructuring of the program, AI/AN families are especially at risk. They face many problems including higher rates of poverty and uninsurance and they depend on Medicaid significantly more than other families.