Jennifer Haley

Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled in Public Health Insurance Programs?

OBJECTIVE. We examined potential barriers to enrollment in public programs among low-income children with special health care needs who are uninsured. Barriers considered include parents not knowing about the Medicaid and State Childrens Health Insurance programs, not believing that their child is eligible for public coverage, not perceiving the enrollment processes as easy, and not wanting to enroll their child in a public program. METHODOLOGY. The source of data is the 2001 National Survey of Children With Special Health Care Needs. A series of 5 questions about the childs health needs, known as the Children With Special Health Care Needs Screener, was used to identify children with special health care needs. Uninsurance is defined as having no insurance coverage at the time of the survey. Low-income families are defined as those with household incomes below 200% of the federal poverty level. The analytic sample consists of 968 low-income uninsured children with special health care needs. We examined the socioeconomic and demographic characteristics of the sample, the reasons the children lack coverage, and the awareness and perception measures, both individually and combined as a summary measure. RESULTS. Many low-income parents with uninsured children with special health care needs do not have full information about Medicaid and State Childrens Health Insurance programs or do not have positive perceptions of the application processes. Although 93.5% had heard of at least 1 of the 2 programs, only 54.6% believed that their child was eligible for public coverage, and just 48.1% believed that the application processes were easy. Almost all said that they would enroll their child if told he or she was eligible for public coverage. CONCLUSIONS. Understanding why uninsured children with special health care needs do not participate in public programs is important, because these programs have the potential to cover almost all of this population. Initiatives to increase enrollment should yield real dividends given that the vast majority of low-income uninsured children with special health care needs have parents who say they would enroll their children in public coverage.

Variation in Medicaid Eligibility and Participation among Adults: Implications for the Affordable Care Act:

Steep declines in the uninsured population under the Affordable Care Act (ACA) will depend on high enrollment among newly Medicaid-eligible adults. We use the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults. We identify 4.5 million eligible but uninsured adults. We find a Medicaid participation rate of 67% for adults; the rate is 17 percentage points lower than the national Medicaid participation rate for children, and it varies substantially across socioeconomic and demographic subgroups and across states. Achieving substantial increases in coverage under the ACA will require sharp increases in Medicaid participation among adults in some states.

Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?

OBJECTIVE To assess how many uninsured children are eligible for coverage through Medicaid or the Childrens Health Insurance Program (CHIP) but not participating and examine the reasons low-income uninsured children are unenrolled. METHODS Medicaid/CHIP eligibility and participation are estimated for a sample of over 1.4 million children in the 2008 and 2012 American Community Survey. Medicaid/CHIP experience and enrollment barriers are examined for 2300 uninsured children in families with incomes below 200% of the federal poverty level in the 2011-2012 National Survey of Childrens Health. RESULTS Despite increases in the number eligible for Medicaid or CHIP between 2008 and 2012, participation rose nationwide by 6 percentage points; by 2012, 21 states and the District of Columbia had participation rates for children of 90% or higher. The number of eligible but uninsured declined from 4.9 to 3.7 million, but 68% of uninsured children in 2012 qualified for Medicaid or CHIP. Interest in enrolling uninsured children in Medicaid or CHIP is high (more than 90% of parents say they would enroll their child), but despite the high rates of prior enrollment, many families had knowledge gaps and perceived difficulties with enrollment. CONCLUSIONS Addressing enrollment/retention barriers and raising Medicaid/CHIP participation in low-performing states hold promise for reducing the number of eligible but uninsured children given the diverse set of states with high participation and the high expressed interest in enrolling children.

Coverage Gaps for Medicaid-Eligible Children in the Wake of Federal Welfare Reform

Using data from the National Survey of Americas Families, this paper examines insurance coverage changes for Medicaid-eligible citizen children between 1997 and 1999, early in the implementation of federal welfare reform. More than 20 million children qualified for Medicaid, but many were uninsured. Insurance coverage deteriorated for eligible children between 1997 and 1999, particularly for those who also qualified for cash assistance; this deterioration in coverage was largely due to dramatic declines in cash assistance participation. This paper shows that following federal welfare reform, states have faced new challenges reaching and enrolling the growing numbers of eligible children who are not connected with the welfare system.