Report Finds Child Uninsured Rate Improved in 2022, Warns Progress Under Threat as Eligible Children Lose Coverage During Medicaid Unwinding

This week we were joined by Stacey Pogue, a senior policy analyst with Every Texan and Dr. Valerie Borum Smith, a pediatrician and President-Elect of the Texas Society of Pediatricians to release our annual report on child health coverage trends.

Our report showed the number of uninsured children declined in 2022 to one of the lowest levels in history due largely to a federal law designed to ensure children, parents and others enrolled in Medicaid had stable coverage during the pandemic. The uninsured rate for children was 5.1% in 2022 compared to 5.7% in 2019, the year before Medicaid’s pandemic-era continuous coverage protection was put in place. Nationally, child uninsured rates fell across demographic groups, with children of nearly every age, race and ethnicity, and family income level seeing an improvement. American Indian and Alaska Native children and children in low-income families saw the biggest reductions in their uninsured rates.

This shows that removing barriers to Medicaid enrollment is an effective way to keep kids covered. Unfortunately, this positive trend is likely short-lived.  We expect next year’s report to show more children have become uninsured as a result of states winding down continuous coverage protections. Most of the children losing coverage are likely still eligible. We anticipate the coverage losses will be greatest in states where leaders are not prioritizing the needs of children.

Our state-by-state analysis found a statistically significant improvement in the rate and/or number of uninsured children in 21 states. Wyoming, North Dakota, Utah, New Mexico, and Texas experienced the greatest improvements in child health coverage. Only four states — Iowa, Maryland, Pennsylvania, and Wisconsin — saw statistically significant increases in child uninsurance rates between 2019 and 2022, according to the U.S. Census Bureau’s American Community Survey data we analyzed for the rerpot. Texas has the highest child uninsured rate in the nation – more than double the national rate.

“This report has such a hopeful message for Texas,” Pogue said during a press call to release the report. “The report shows that when Texas was forced to remove barriers to coverage during the pandemic, the child uninsured rate improved.  Sadly, now that those federal protections have expired, children are back in harm’s way and Texas has become ground zero for children losing health coverage. No state has cut off Medicaid to more children than Texas and this report shows that no state has a worse record on the number of uninsured children. Alarmingly, for 4 in 5 Texas kids removed from Medicaid, the state did not confirm whether the child remained eligible or not and it’s likely that most still qualify.”

Dr. Smith, who treats a large number of children covered by Medicaid in Tyler, Texas, explained how vital continuous eligibility protection had been to paitents like hers during the pandemic and how gaps in insurance coverage greatly affect whether parents seek help for their children. “The gains in Medicaid coverage we have seen over the past few years have been vital in keeping patients like mine safe and healthy,” said Dr. Smith on the press call. “Young people have faced crisis after crisis, from a years-long pandemic to last fall’s surge in pediatric respiratory illnesses to the ongoing youth mental health emergency. Disrupting access to affordable, quality care threatens the physical and mental health of kids and teens across the board. We must do everything we can to keep families covered.”

You can find information about child health coverage trends in your state in this year’s report and take a deeper dive on our State Data Hub.