Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?

Kenney, Genevieve M.; Haley, Jennifer; Anderson, Nathaniel; Lynch, Victoria

doi:10.1016/j.acap.2015.01.009

Cited by 33 publications

(21 citation statements)

References 3 publications

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“…7 However, eligibility for Medicaid and CHIP is not universal among low-income children. Most children who are undocumented immigrants remain ineligible for these programs, and only certain groups of immigrants qualify for public coverage depending on their state of residence.…”

Section: Health Insurance Options For Low-income Familiesmentioning

confidence: 99%

The Role of Public Health Insurance in Reducing Child Poverty

Wherry

Kenney

Sommers³

2016

Academic Pediatrics

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Over the last thirty years, there have been major expansions in public health insurance for low-income children in the U.S. through Medicaid, the Children’s Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its impact on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out-of-pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out-of-pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for both health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation’s public health insurance programs have many important short and long-term poverty-reducing benefits for low-income families with children.

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Section: Health Insurance Options For Low-income Familiesmentioning

confidence: 99%

The Role of Public Health Insurance in Reducing Child Poverty

Wherry

Kenney

Sommers³

2016

Academic Pediatrics

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“…Express Lane Eligibility (ELE), a new policy option permitted by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), enables states' Medicaid and/or Children's Health Insurance Program (CHIP) programs to use another agency's eligibility findings to qualify children for public health insurance coverage at either initial enrollment or at renewal, even if programs use different methods to assess income or otherwise determine eligibility. ELE is a potential solution to 2 vexing and persistent problems: first, enrolling eligible but uninsured children, estimated at 3.7 million children in 2012, representing about 68.4% of all uninsured US children at that time 1 ; and second, churning, when children reenroll into Medicaid or CHIP after a gap in coverage. 2,3 States operationalize ELE by partnering with any of 11 types of state agencies to obtain data that will support Medicaid and/or CHIP eligibility determination (except the US citizenship criterion, which must be determined through normal means).…”

mentioning

confidence: 99%

Spotlight on Express Lane Eligibility (ELE): A Tool to Improve Enrollment and Renewal

Hoag

2015

Academic Pediatrics

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“…The results suggest that providing health insurance to all Medicaid/CHIP-eligible US children could save billions of dollars annually for our nation. Multiplying a cost savings of $2885.75 per child per year times the 3.0–3.5 million Medicaid/CHIP-eligible uninsured children in the US [5–8] yields potential annual savings of $8.7–$10.1 billion. But these savings cannot be realized until successful outreach and enrollment is achieved for these 3.0–3.5 million Medicaid/CHIP-eligible uninsured children.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 4.8 million uninsured children in America, 62–72% (3.0–3.5 million) are eligible for but not enrolled in Medicaid or CHIP [5–8]. Not enough is known, however, about the impact of Medicaid/CHIP coverage on outcomes for previously uninsured children, particularly regarding subsequent quality of care, parental satisfaction, out-of-pocket costs, family financial burden, and overall costs.…”

Section: Introductionmentioning

confidence: 99%

The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study

et al. 2017

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BackgroundOf the 4.8 million uninsured children in America, 62–72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively.MethodsThis prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year.ResultsIn this sample of 237 children, those obtaining coverage were significantly (P < .05) less likely than the uninsured to have suboptimal health (27% vs. 46%); no PCP (7% vs. 40%); experienced never/sometimes getting immediate care from the PCP (7% vs. 40%); no usual source of preventive (1% vs. 20%) or sick (3% vs. 12%) care; and unmet medical (13% vs. 48%), preventive (6% vs. 50%), and dental (18% vs. 62%) care needs. The uninsured had higher out-of-pocket doctor-visit costs (mean = $70 vs. $29), and proportions of parents not recommending the child’s healthcare provider to friends (24% vs. 8%) and reporting the child’s health caused family financial problems (29% vs. 5%), and lower well-child-care-visit quality ratings. In bivariate analyses, older age, birth outside of the US, and lacking health insurance for >6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4–10.3) and African-American children (OR, 2.8; 95% CI, 1.1–7.3) had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04).ConclusionsProviding health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7–$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children.

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Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?

Cited by 33 publications

References 3 publications

The Role of Public Health Insurance in Reducing Child Poverty

The Role of Public Health Insurance in Reducing Child Poverty

Spotlight on Express Lane Eligibility (ELE): A Tool to Improve Enrollment and Renewal

The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study

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