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Addressing Coverage Challenges for Children Under the Affordable Care Act

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Document date: May 31, 2011
Released online: May 31, 2011


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.

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

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