Maximizing insurance coverage for children under the Affordable Care Act will require considering how the new system and its rules will apply to children facing complex coverage scenarios. The purpose of this brief is to explore several scenarios in which children may face particular challenges in accessing health insurance coverage. We find that roughly 20 million children live in situations that create particular challenges in accessing insurance coverage due to within-family variation in eligibility for different types of coverage and that nearly 28 million children live apart from at least one of their parents, creating additional complexities in accessing coverage.
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The Patient Protection and Affordable
Care Act introduces many changes to
the health insurance landscape in the
United States. Medicaid eligibility will
be expanded to a mandatory minimum
138 percent of the federal poverty level
(FPL) for all individuals in 2014. This
will dramatically increase eligibility for
both parents and childless adults. The
law also calls for the establishment of
state-based health insurance exchanges.
The exchanges will be organized markets
where individuals and small businesses
can purchase health insurance coverage
that is subject to new regulations
intended to spread risk more broadly
and promote competition in the market
for health insurance. Low- and moderateincome
individuals and families with
incomes up to 400 percent of the FPL
will also be eligible for federal subsidies
to purchase coverage in the exchanges
if they do not have affordable access to
employer-based insurance. With these
new options in place, most individuals
will be required to obtain a minimum
level of coverage or pay a penalty.
While children have generally fared
better than adults in obtaining health
insurance coverage because of more
expansive eligibility under Medicaid
and CHIP, certain children face special
challenges in obtaining insurance due
to complex coverage options and family
situations. Some children have parents
with employer-sponsored insurance
that does not cover dependents. Others
are eligible for Medicaid or CHIP, but
their parents are not. This can be due to
different income eligibility thresholds for
adults and children or differences related
to citizenship and documentation status.
Children living apart from one or both
parents are often subject to complex
health insurance choices. The ACA will
open up new avenues to coverage for
many children and families, but it will
be important to consider how the new
system and its rules will apply to children
facing complex coverage scenarios.
The purpose of this brief is to explore
several scenarios in which children
may face particular challenges in
accessing health insurance coverage.
We will estimate the number of children
for whom each scenario applies and
consider whether these populations
require additional attention in order
to make the changes under the ACA
function most effectively for them. An
awareness of the special circumstances
of these children as regulations are
developed and the law is implemented
will help ensure they are able to access
health insurance coverage under reform.
End of excerpt. The entire brief is available in PDF format.