In Medicaid Expansion States, Fewer Young Children Go Uninsured

boy at doctor's office

Thanks to developments since the start of the new year, this post can start with some good news for young children: three more states have made progress toward expanding Medicaid. Last week, Kansas Democratic Gov. Laura Kelly and Republican Sen. Jim Denning announced plans to move forward to with Medicaid expansion when the legislative session starts next week. And as of January 1, Utah and Idaho have both expanded Medicaid to all adults up to 138 of the federal poverty level, though with work requirements for some adults.

This matters for young children because last month, we released a sobering report pointing to significant increases in the uninsured rate for babies, toddlers and preschoolers. In 2018, more than one million of our nation’s children under age 6 were uninsured, putting them at risk of missing out on the routine screenings and immunizations they need in the early years to catch delays and set children on the path for success in school and life.

Young children who lived in states that haven’t expanded Medicaid lost coverage at faster rates than kids in expansion states. The rate of uninsured, young children grew nearly three times as fast in non-expansion states as the rate among expansion states, and non-expansion states had and average uninsured rate of 5.9 percent, compared to just 3.3 percent for expansion states.

In 2018, expansion states were more likely to have rates of uninsured, young children at or below the national average of 4.3 percent than non-expansion states. Texas’ rate, at 8.3 percent of children under age 6 uninsured, was nearly double the national average.

This disparity is troubling, but we know how to fix it. In every state that has expanded Medicaid, there’s been a “welcome mat” effect where children have gained coverage alongside their parents and other low-income adults newly eligible for coverage. The latest example is in Virginia, where, since the state began Medicaid expansion enrollment in January 2019, more than 25,000 children enrolled in Medicaid and CHIP along with 110,000 parents. Children in Idaho, Utah and Kansas may soon experience the welcome mat effect too.

The widening gap between expansion and non-expansion shows that expanding Medicaid to parents and other adults is essential for children’s healthy development, particularly in the early years. Young children’s healthy brain development is directly tied to the strength of their relationships with parents and caregivers.

When parents don’t have coverage, they’re more likely to struggle with managing their own health and daily parenting challenges, and less likely to access treatment. In Idaho, Anita Sackuvitch, a single mom of two children and a caregiver in an assisted living facility who just became eligible for Medicaid coverage on January 1, shared how last year, she had to have emergency surgery because she ignored warning signs of a medical problem. “I was scared of the expense and didn’t think it was anything serious…I almost died. Had I waited any longer, I would have,” Sackuvitch wrote in a blog for CCF.

As Anita’s story illustrates, coverage is also critical for family economic security. When a parent or child lacks coverage, the family is exposed to medical debt and even bankruptcy from an unexpected injury or illness. Anita’s emergency surgery left her with $19,000 in medical debt, and that was after the hospital’s indigent fund reduced it from $50,000. For parents of young children in particular, medical debt can be especially crushing. Young children experience the highest poverty rates of any age group, putting their families at greatest risk for financial hardship if faced with an unexpected bill.

Among the 13 states with significant increases in the rate of uninsured babies, toddlers and preschoolers between 2016 and 2018, three states—all without Medicaid expansion—stood out. Between them, Florida, Georgia and Texas were home to 32 percent of all uninsured young children in the U.S., with Texas far and away leading the group with 198,014 uninsured young children in 2018. Expanding Medicaid in these and the 14 other remaining states would go a long way to support young children who need healthy caregivers to reach their full potential.

As my colleague Elisabeth Wright Burak pointed out in a blog last month, health coverage is the foundation that all other early childhood investments—including high quality Pre-K and home visiting—rest on. Consistent, affordable and high-quality health coverage for parents is essential to ensure that every child has the chance to reach their full potential.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.