Key Findings
- Between 2022 and 2024, the share of young children under age 6 who were uninsured increased by a full percentage point, from 4.3 to 5.3 percent, reaching the highest uninsured rate for young children in nearly a decade. Nearly 220,000 additional babies, toddlers and preschoolers were uninsured in 2024 – a 23% increase between 2022 and 2024.
- Texas (10.8%), North Dakota (9.8%), Arizona (9.0%), Wyoming (8.5%), Idaho (7.9%), Arkansas (7.6%), Florida (7.6%), and Oklahoma (7.5%) have the highest rates of uninsured children under 6 nationwide in 2024. Thirteen states had significantly higher rates of uninsurance for children under age 6 than the national rate of 5.3 percent.
- The percentage growth in the number of uninsured children under age 6 between 2022-2024 outpaced the growth among school-aged children in the U.S. and in 9 states: Alabama, Arkansas, Illinois, Florida, Kansas, Missouri, North Dakota, Texas, West Virigina.
- The increased number of uninsured children under age 6 in three large states (Texas, Florida, and Georgia) accounted for more than half of the national increase.
- Uninsured rates were higher for young children of color. American Indian and Alaska Native children under age 6 have the highest rate of uninsurance of any racial or ethnic group (10.5%) nationally.
The number of infants, toddlers and preschoolers who are uninsured is at the highest level in nearly a decade and is increasing more sharply than for older children. The number of uninsured children under age 6 grew by 23% between 2022 and 2024, while the number of uninsured school-aged children grew by 17%. The charts and appendix tables provide additional detail on uninsurance trends and rates for children in each state.
Introduction
Health insurance allows families to get needed health care without fear of bankruptcy or economic fallout. Children have the highest poverty rate of any age group, and five years of survey data among parents with young children show persistent challenges meeting basic needs. In June 2025, nearly half of parents of young children reported difficulty in the past month meeting basic needs of their children, which included utilities, food, health care, housing and child care. This material hardship is also associated with reported emotional distress for parents and children.
The earliest years of life are a critical time for rapid development propelled by nurturing relationships that can put children on a path to long-term success. While children as a group are the least expensive to cover, individually they require frequent access to care – especially during the early years – to monitor and support healthy development. Children with health coverage are more likely to access needed checkups and follow-up care. Children with health coverage are more likely to access needed checkups and follow-up care. The American Academy of Pediatrics recommends more frequent primary care visits from birth to age three to monitor developmental milestones and intervene where more support may be needed, including mental health services. These regular well-child visits offer the broadest touchpoint to children and their families before they enter school.
Children without health coverage experience additional barriers to needed preventive and specialty care. For young children, especially, lack of coverage can mean missed opportunities for early intervention during children’s most rapid period of brain development that can be more complex and costly to address as children get older. Increasing rates of uninsured young children make national priorities, such as kindergarten readiness, much harder to achieve.
Troubling State Trends in Uninsurance Rate for Children Under Age 6
The uninsured rate for young children rose to its highest level in nearly a decade in 2024 (the most recent data available.) (Figure 1). The number of uninsured children under age 6 increased more sharply than among school-aged children nationally and in 9 states (Figure 3). Older children remain more likely than children under age 6 to be uninsured. Bucking the national trend, three states had uninsured rates for children under age 6 that were significantly higher than the rate for children ages 6 to 18 in 2024 (North Dakota: 9.8% vs. 5.6%; Pennsylvania: 6.0% vs. 5.2%; and West Virginia: 3.7% vs. 2.5%)
The uninsured rate went in the wrong direction in 16 states that experienced a significant increase in both the number and rate of young, uninsured children between 2022 and 2024 (Figure 5). Connecticut was the only state that saw a statistically significant improvement in the uninsured number and rate for young children (See Appendix Tables).
Medicaid, along with the smaller Children’s Health Insurance Program (CHIP), is a critical source of coverage for young children, covering nearly three-fourths of low-income young children under age six. More than half of uninsured children are likely eligible for, but not enrolled in Medicaid or CHIP. Medicaid enrollment declines, such as those driven by disenrollments during the Medicaid unwinding, typically lead to increases in the rate of child uninsurance, as our prior research has demonstrated. These negative trends are troubling as young children must access timely, appropriate care early in life to set them up for long-term success. Research by the Congressional Budget Office is clear that government spending on child Medicaid has a positive return on investment of taxpayer dollars. The nonpartisan Congressional Budget Office (CBO) estimates that one additional year of Medicaid continuous coverage in childhood improves labor outcomes in adulthood including higher earnings, hours worked, and labor productivity.
Conclusion
The uninsured rate for infants, toddlers and preschoolers increased from 2022 to 2024 as it did for all children. This is likely due at least in part to the unwinding of the Medicaid continuous coverage protection that had been in place during the COVID-19 pandemic. Young children and their families need access to affordable health care to grow and thrive, making these troubling trends a warning sign for families and policymakers.
Press Release
State Appendix Tables
Methodology
Data Sources
This brief from the Georgetown University Center for Children and Families (CCF) analyzes data from the U.S. Census Bureau’s American Community Survey (ACS) for 2015-2024. Because of differences in sample size and data processing, the estimates published here may differ from estimates produced using other ACS products.
Margin of Error, Statistical Significance, and Data Reliability and Suppression,
The Census Bureau provides a margin of error (MOE) at a 90% confidence level for each estimate it publishes. CCF also calculates MOEs using formulas provided by the Census Bureau for estimates calculated with ACS data.
CCF uses the Census Bureau’s Statistical Testing Tool to determine statistical significance between estimates at a 90% confidence level. Differences between estimates should not be assumed to be statistically significant unless noted.
CCF calculates coefficients of variation (CVs) to measure data reliability for each estimate. CCF suppresses any estimate with a CV greater than 25 percent.
Geographic Areas
Data are analyzed at the national and state levels. Data on uninsured rates are suppressed in several states in accordance with data reliability standards above.
Health Insurance Coverage and Medicaid Undercount
ACS data represent a “point-in-time” estimate of an individual’s insurance coverage. The Census Bureau does not consider access to Indian Health Service (IHS) services alone as a comprehensive form of health insurance coverage; individuals who indicate that IHS is their only source of coverage are designated as uninsured.
ACS estimates are not adjusted by the Census Bureau (or by CCF) to address the “Medicaid undercount” observed when comparing the number of individuals covered by Medicaid/CHIP in surveys to the reported numbers of individuals enrolled in Medicaid/CHIP using federal and state administrative data. In 2022, the Medicaid continuous coverage provision may affect children’s reported coverage source—including uninsurance—if more misreported their coverage source including families who were unaware that they still had Medicaid coverage. Additionally, research on the decennial Census shows that young children in particular are undercounted, likely exacerbating the Medicaid undercount among children.
Demographic Characteristics
The ACS allows respondents to self-identify as the following races: White, Black/African-American, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, “Some other race,” and “Two or more races.” To improve sample sizes and data reliability, CCF combines estimates for Asian and Native Hawaiian or Other Pacific Islander and reports the calculations as “Asian, Native Hawaiian, or Other Pacific Islander” and also combines “Some other race” alone and “Two or more races” and reports the calculations as “Other/Multiracial.” Except for Other/Multiracial, all racial categories refer to individuals who reported belonging only to one race.
The Census Bureau recognizes and reports race and Hispanic origin (i.e., ethnicity) as separate variables. As “Hispanic or Latino” refers to a person’s ethnicity, Hispanic and non-Hispanic individuals may be of any race.