By Genevieve M. Kenney and Nathaniel Anderson, Urban Institute
We keep a close eye on fluctuations in the participation rate in Medicaid and the Children’s Health Insurance Program (CHIP) because it is so critical to efforts to bring down the uninsured rate for children. Our latest data found that children’s participation in Medicaid/CHIP was 88.3 percent nationwide in 2013.[i] While this is not a statistically significant change from the prior year, it shows that we’re holding onto the gains ushered in since policies aimed at encouraging enrollment and retention were put in place as part of CHIPRA in 2009. Between 2008 and 2013, Medicaid/CHIP participation rates increased by 6.6 percentage points among children, rising from 81.7 percent to 88.3 percent.
Increases in Medicaid/CHIP participation were widespread over this time period—41 states states saw statistically significant increases in Medicaid/CHIP participation among children. In 2013, 23 states had a participation rate above 90 percent and just two had a participation rate below 80 percent; this compares to 5 states with rates above 90 percent and 15 states with rates below 80 percent in 2008. Each year between 2008 and 2012, there had been a statistically significant increase in Medicaid/CHIP participation for children on a national basis, but progress seemed to stall out between 2012 and 2013, albeit at a very high level–while the 2013 rate of 88.3 percent was slightly higher than rate of 88.1 percent found in 2012, the increase was not significant at conventional levels (P < .10).[ii]
Eligible but Uninsured
Reductions in the number of uninsured children who are eligible for Medicaid/CHIP but not enrolled have accompanied the hikes in Medicaid/CHIP participation rates (Exhibit 2). Between 2008 and 2013, the number of eligible but uninsured children fell from 4.9 million in 2008 to 3.7 million in 2013, despite increased numbers of eligible children over that period.[iii] [iv] As with the participation rates, significant changes in the number of eligible but uninsured children were found in prior years after 2008, but not between 2012 and 2013.
Looking Ahead
These data, while the most recent available, are from 2013, which is before the major coverage provisions of the Affordable Care Act (ACA) were implemented. Ultimately, full implementation of the ACA is expected to further reduce uninsurance among children, in large part because of the increases in Medicaid/CHIP participation that are expected to result from the “no wrong door” policies in the new health insurance marketplaces, the individual coverage mandate, and new coverage opportunities available for parents through Medicaid and the marketplace.[v] The renewal of CHIP, which was signed into law April 16, 2015 also includes funding for additional outreach and permits states to continue using Express Lane Eligibility strategies to enroll children in Medicaid and CHIP. [vi] [vii] It will be important to track coverage for children at both the national and state level to assess whether participation in Medicaid/CHIP rises further in 2014 and 2015 and continues the upward trend that had occurred between 2008 and 2012.
[Editor’s Note: This analysis was funded in part by the Robert Wood Johnson Foundation. To view the children’s participation rate in Medicaid/CHIP in your state, click here.]
[i] Participation rates are defined as the ratio of Medicaid/CHIP-eligible enrolled children to Medicaid/CHIP-eligible enrolled children plus Medicaid/CHIP-eligible uninsured children. For more information on data and methods, see Kenney, GM, JM Haley, N Anderson, and V Lynch. 2015. “Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?” Academic Pediatrics 15(3S); S36-S43.
[ii] Between 2012 and 2013, Medicaid/CHIP participation rates for children increased in 23 states; in 3 of these states, the increase was significant at the .10 level (CA, NC, and SC). Over that same period, participation rates decreased in 28 states, but only two of these decreases were significant at the .10 level (IL and SD).
[iii] Kenney, GM, JM Haley, N Anderson, and V Lynch. 2015. “Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?” Academic Pediatrics 15(3S), S36-S43.
[iv] Additionally, the total number of uninsured children fell from 7.2 million in 2008 to 5.4 million in 2013.
[v] Dubay, L, M Buettgens, and GM Kenney. 2015. “Estimates of Coverage Changes for Children Enrolled in Separate Children’s Health Insurance Programs in the Absence of Additional Federal CHIP Funding—Key Findings and Methodology.” Report to Medicaid and CHIP Payment and Access Commission. Washington DC: The Urban Institute. /wp-content/uploads/pdfs/Estimates-of-Coverage-Changes-for-Children-Enrolled-in-Separate-Childrens-Health-Insurance-Programs-in-the-Absence-of-Additional-Federal-CHIP-Funding.pdf.
[vi] Medicare Access and CHIP Reauthorization Act of 2015, Pub. L. No. 114-10 (2012).
[vii] Blavin, F, GM Kenney, and M Huntress. 2014. “The effects of express lane eligibility on Medicaid and CHIP enrollment among children.” Health Services Research. 49(4); 1268-1289.
