This brief examines whether neighborhood conditions, including medical access, food hardship, housing, and environmental risks, vary with the share of children who rely on Medicaid or the Children’s Health Insurance Program (CHIP) for health insurance coverage.

WHY THIS MATTERS

As the insurance provider to close to 40 million children, Medicaid and CHIP have an outsized opportunity to shape health outcomes and equity for low-income children up to 19 years old. In addition to Medicaid financing of health care services, the neighborhood environment plays an important role in shaping health and providing access to important resources that affect quality of life. Neighborhoods with greater access to resources, such as high-quality education and employment opportunities, tend to have better health outcomes. Conversely, less-resourced neighborhoods have limited access to healthy food sources, medical providers, quality education, and quality jobs with paid time off and are associated with poorer child health outcomes.

Yet, there is little information that documents where Medicaid-enrolled children live or the conditions of their neighborhoods that may affect their health or access to health care. Understanding where children covered by Medicaid and CHIP live and whether their neighborhoods are systematically different from those of children with private health insurance has important equity implications.

WHAT WE FOUND

• Children with Medicaid/CHIP coverage are heavily concentrated in a subset of tracts: overall, 41 percent of children with Medicaid/CHIP coverage live in the quintile of tracts that have the highest prevalence of children relying on Medicaid/CHIP for their health insurance coverage and more than two-thirds (68.2 percent) live in the top two quintiles with the highest prevalence of children relying on Medicaid/CHIP.
• Geographic areas where children rely on Medicaid and CHIP coverage at higher rates tend to have older housing stocks; higher rent burdens; lower food access; a greater likelihood of being designated as medically underserved or having shortages of primary care, dental, or mental health providers; and higher risks for cancer because of air pollution or a higher concentration of diesel particulate matter. They are also more likely to be near EPA-listed Toxics Release Inventory sites compared with geographic areas with lower rates of children with Medicaid/CHIP coverage.
• Tracts with a higher share of children with Medicaid/CHIP tend to be the ones with lower share and lower concentration of children with employer-sponsored insurance (ESI) and vice versa (e.g., just 7.4 percent of all children with ESI coverage live in tracts where children rely on Medicaid and CHIP coverage at the highest rates compared with 40.6 percent of all Medicaid/CHIP-enrolled children; and 31.4 percent of all ESI-enrolled children live in tracts where children rely on Medicaid and CHIP at the lowest rates compared with 3.3 percent of all children with Medicaid/CHIP coverage). These patterns mean that Medicaid/CHIP-enrolled children are more likely to live in areas with environmental risks and resource-access issues relative to children with ESI.
• There is no consistent association across census tracts between the share of children with Medicaid/CHIP coverage and the share of children who are uninsured.

HOW WE DID IT

We examine these associations using the census tract of residence and data from the American Community Survey 2015–2019 5-Year Data, the Agency for Healthcare Research and Quality Social Determinants of Health database, and the Environmental Justice Index developed by the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease R