Another Sign that We Can Do Better in Covering Children Who are Eligible but Not Enrolled in Medicaid

A new report from the Urban Institute finds that participation of uninsured children in Medicaid and CHIP stalled in 2018. While this analysis lags behind the latest data (2019) on health insurance status released by the Census Bureau’s American Community Survey last month, it continues to show the direct correlation between the child insurance rate and participation in Medicaid and CHIP. As more children eligible for Medicaid and CHIP participate in the program, the higher the rate of children with health insurance. But since achieving the historic milestone of coverage for 95.7 percent of children in 2016, the rate of insured children has declined along with the share of eligible children enrolled (participating in) in Medicaid and CHIP.



For decades, we knew that many uninsured children were eligible but not enrolled in Medicaid and CHIP. However, health coverage is a moving target, with people continually moving in and out of coverage or encountering circumstances that change their eligibility for private or public coverage. So, we can only estimate the eligibility of uninsured children for Medicaid or CHIP by looking at variables such as income or immigration status. The Urban Institute analysis gives us a better assessment of potential eligibility.

Bottom line is that as the share of children with health insurance has declined after peaking in 2016, the number of children who are eligible but not enrolled in Medicaid or CHIP has grown. In fact, the Urban Institute estimates that 57.4 percent of the uninsured children in 2018 were eligible but not enrolled in Medicaid or CHIP. Moreover, in 2018, 39 states had more than 10,000 children who were eligible but not enrolled in Medicaid or CHIP with Texas topping the list with 385,000 children (18.1 percent of all eligible but not enrolled children nationwide).

There are many reasons that children are eligible but not enrolled in Medicaid or CHIP, ranging from a lack of outreach and public awareness to burdensome enrollment and renewal processes to the chilling effect of hostile immigration policy. We can and should do more to ensure that all children have access to the health care they need to succeed in school and in life, starting with focusing on groups of uninsured children who are more likely to eligible. These include adolescents, Latino and Indigenous children, and eligible children in mixed-immigration status families.

Medicaid has an important role to play and can be a leader in covering children. If all eligible children were in enrolled in Medicaid and CHIP in 2018, the number of uninsured children would have been 1.6 million, not 3.7 million. We can also take lessons for Medicare, where signing up for coverage requires the completion of a simple one-page form once. As a result, more than 99 percent of seniors are covered in the U.S. We should not be satisfied until we can say the same thing about children.

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.