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Progress Enrolling Children in Medicaid/CHIP: Who is Left and What are the Prospects for Covering More Children? (Updated 12/14/09)

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Document date: November 13, 2009
Released online: December 14, 2009


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.

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The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 gave states additional resources and tools aimed at improving participation in Medicaid and the Children's Health Insurance Program (CHIP). In 2007, five million uninsured children were eligible for Medicaid or CHIP, constituting 64 percent of all uninsured children. Nationwide, over 80 percent of eligible children participated in Medicaid/CHIP, but participation rates, as well as the characteristics of uninsured eligible children, vary dramatically across areas.

Efforts to streamline application and retention processes offer tremendous potential for increasing enrollment among the eligible children who are uninsured. Over 90 percent of low-income parents say they would enroll their uninsured child if he or she was eligible, but around half do not know that their child is eligible, do not know how to apply, or find the application processes difficult. In order to close coverage gaps, states may also need to undertake targeted outreach efforts aimed at teenagers, Hispanics, and other groups of children with lower than average participation rates, provide additional support for community-based application assistance, broaden their outreach strategies to include parents, and address existing barriers in their Medicaid and CHIP application and retention processes.

Since almost all uninsured low-income children live in families that participate in other government programs or file taxes, states have a number of promising vehicles for covering more eligible children. States can take advantage of new express lane provisions in CHIPRA to make use of more data-driven enrollment and retention processes in order to minimize burdens on families. This analysis indicates that states will likely succeed in further increasing participation and reducing uninsurance among children if they take steps to improve their enrollment and retention processes, and tailor their outreach strategies to the particular needs of the uninsured children who are eligible for coverage in their state. States will be aided in designing their outreach approaches by newly available data that provide detailed information about health insurance coverage at the state and local level.

However, uncertainty about the future role of Medicaid and CHIP in covering children combined with ongoing state budget difficulties may make states reluctant to move aggressively to cover more children in the near term. An extension of higher federal matching rates in Medicaid could mitigate this latter problem. Current health care reform proposals include a mandate requiring individuals to obtain health insurance coverage and expansions of Medicaid to cover more parents, both of which would likely increase participation among eligible children. These findings suggest that expanding Medicaid as a part of health care reform will be a successful strategy for reducing uninsurance, but that careful attention must be given to enrollment and retention processes so as to minimize gaps in coverage.

(End of excerpt. The entire report is available in PDF format.)

Topics/Tags: | Children and Youth | Health/Healthcare

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