Research by Author & Topic

Publications by Genevieve M. Kenney on Medicaid

This brief examines the characteristics of the children who were eligible for Medicaid/CHIP in 2007. The results show that while participation rates were high in both Medicaid and CHIP, some 5 million remained uninsured despite being eligible for coverage. Participation rates, which were found to vary across areas, have likely increased given recent declines in the number of uninsured children. The brief also shows that while interest in public coverage is high among low-income parents, many do not know not know that their child is eligible for Medicaid/CHIP, do not know how to apply, and/or find the application process difficult.

New data on health insurance coverage from the American Community Survey show extensive variation in rates of private and public coverage and uninsurance across congressional districts in the United States. Rates of private coverage are lowest in districts that have higher poverty rates which tend to be concentrated in the South and West and uninsurance remains most serious in districts with low rates of private coverage. This analysis identifies the districts in which residents would have the most to gain from health reforms that are designed to increase health insurance coverage toward a higher and more uniform national standard.

This brief examines the potential effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children's Health Insurance Program (CHIP). Increased parental coverage will help these children since many have uninsured parents with unmet health needs. However, proposals to move these children into a new health insurance exchange could make them worse off through the potential loss of benefits and legal protections and possible exposure to higher cost-sharing; alternatively, if reimbursement rates are higher in the exchange than paid under Medicaid and CHIP, children's access to providers could improve.

With the reauthorization of the State Children’s Health Insurance Program (SCHIP) under consideration in early 2009, an important question is the extent to which uninsured children could be covered under employer-sponsored insurance (ESI) through premium assistance programs. Only 440,000 uninsured children who are eligible for Medicaid or SCHIP have at least one parent with ESI coverage. Since many more uninsured children are eligible for public programs than have access to ESI through their parents, policies to increase enrollment and retention in Medicaid and SCHIP have much greater potential than premium assistance programs to close coverage gaps among children.

As the reauthorization of the State Children's Health Insurance Program (SCHIP) and broader health care reform efforts are considered, important policy questions include where eligibility thresholds should be set for public coverage and how much latitude states should have in setting their thresholds. This analysis shows that employer-sponsored insurance premiums are less affordable for families at 300 percent of the FPL now than they were for families at 200 percent of the FPL in 1996, particularly in areas with a high cost of living and suggests the need to adjust eligibility thresholds for growth in health care costs.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

As efforts to reauthorize the State Children's Health Insurance Program (SCHIP) failed in 2007, Congress settled on a short-term extension of the program. The issues that proved contentious in the SCHIP reauthorization debate will likely be revisited when Congress again takes on SCHIP reauthorization later in 2008 or early 2009 when the extension is set to expire. Instead of seeing the reductions in uninsurance among children that were projected under the vetoed SCHIP reauthorization bills, the number of uninsured children will likely increase, at least in the short run. Without strong growth in public coverage, more children are apt to join the ranks of the uninsured, which increased by 1 million over the past two years.

This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

In July 2007, bills to reauthorize the State Children's Health Insurance Program were passed in both the House and the Senate. One question that has been raised is how well the bills target low-income children. In this brief, Genevieve Kenney and colleagues estimate that the proportion of children below 200 percent of the Federal Poverty Level (FPL) covered by the bills is 70% or higher. The share of uninsured children below 200 percent of the FPL who would gain coverage is estimated to be even higher (78 to 85 percent).

In August 2007, the Centers for Medicare and Medicaid Services (CMS) issued a directive requiring that states reach participation rates of 95 percent among children in families with income below 200 percent of the federal poverty line in Medicaid and the State Children’s Health Insurance Program (SCHIP) before using SCHIP funds to cover higher-income children. In this brief, Genevieve Kenney shows that there are serious methodological challenges involved with obtaining valid and policy-relevant state-level participation rate estimates. Kenney also reviews recent trends in Medicaid and SCHIP participation rates and comments on participation estimates just released by CMS.