Why is Medicaid/CHIP Continuous Eligibility So Important for Kids?

As readers of SayAhhh! know, the number of uninsured kids was going down for many years, but during the Trump administration starting going back up – rising to 5.7 percent child uninsured rate in 2019. While children are insured at higher rates than non-elderly adults, they still lag considerably behind seniors – who with Medicare happily on the scene – are covered at around 99 percent.

But when you hear that 94 percent of kids have coverage, don’t get complacent. The situation is not that good. The condition of being uninsured is not a static question. While families with higher incomes tend to have more steady coverage, low and moderate income families experienced more coverage churn and periods of uninsurance. We’ve been taking a look at some data from recent years to get a deeper picture of what kids experience.1

What do we see? Well, as the chart below shows, when examining the question of how many children experience a period of uninsurance at some point during the course of a year, the universe of kids affected is considerably larger – basically one in ten. And when looking at children whose families are low or moderate income (below 250 percent of the federal poverty line), the number continues to grow, rising to 13 percent of kids who experience a gap in coverage at some point during a year or are uninsured for the whole year. 

While not an exact proxy for Medicaid/CHIP eligibility, this income cut approximates the national median eligibility level for Medicaid/CHIP (255 percent of FPL). Joan blogged a few weeks ago about the provisions of the House Energy and Commerce reconciliation package that benefit kids and families. From our perspective, the most critical provision for kids in this package is the requirement that all states provide 12 months of continuous eligibility in both Medicaid and CHIP. This policy ensures that when parents sign kids up for public coverage, the kids will have that coverage for one year – in the vast majority of situations.

Today only 24 states do this in Medicaid and 26 do so in CHIP.  A brand new report from MACPAC finds, unsurprisingly, states that have adopted continuous eligibility are less likely to see as much churn.  Our colleague, Tricia Brooks, wrote a companion blog with a deeper dive on the latest from MACPAC and the importance of continuous eligibility for kids.

These gaps in coverage are unsurprisingly more likely to impact kids in communities of color – 14 percent of Latino kids and almost 12 percent of Black kids experienced uninsurance over the course of a year, while White children were lower than the average for kids overall– although gaps in coverage still affect a sizeable 7.3 percent. By region kids in the South and Midwest are most likely to see gaps in coverage.

Any gap in coverage is a problem. Cost barriers lead to avoidance of needed care, and kids need regular care. As any parent knows, things happen all the time. Ear infections, respiratory viruses, broken bones, asthma, strep infections, a trip to the ER for stitches – all of these are commonplace – no family is immune to them.

And to grow and thrive, regular well-baby and well-child visits are essential to track developmental milestones, receive immunizations and identify and treat acute or chronic conditions so they don’t get worse. Without continuous coverage, children's health needs are less likely to be met and they end up missing school, and families living paycheck to paycheck incur medical debt or have to go without care. In a country where having health insurance is the price of admission to our health care system, it is not acceptable for children to be uninsured for any period of time.

These data show why preventing gaps in coverage for kids is a critical issue for Congressional leaders to advance – especially as they consider questions of health equity. Reducing coverage gaps will reduce racial disparities in coverage rates. This is a critical first step to improving health and educational outcomes for kids of color. It likely won’t cost much for Congress to make this change and any increase in federal Medicaid and CHIP spending will be due to more children having health coverage.  It is an investment in our future that is well worth making.

  1. Georgetown CCF analysis of Agency for Healthcare Research and Quality’s 2018-2019 Medical Expenditure Panel Survey data. Sample includes children under age 19 who had health insurance data reported for all twelve months. Children are considered to be uninsured during the year if they were uninsured in at least one month.