Genevieve Kenney, Senior Fellow

Health Action 2010Families USA

January 28, 2010

jkenney@urban.org /(202) 261-5568

Covering Children in Medicaid/ CHIP: Who Remains Uninsured And What

Are The Prospects for Covering More?

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2

Eligibility of Uninsured Children for Medicaid/CHIP Coverage, 2007

3.2 million

41%

1.8million

23%

2.8millon 36%

Eligible forMedicaid

Eligible forCHIP

Ineligible

7.8 million uninsured children

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

Note: Uninsured estimate reflects an adjustment for the underreporting of public coverage on the CPS.

5.2 million low-income uninsured children

64% of all uninsuredchildren are eligible

88% of all low-incomeuninsured children are eligible

3.2 million

61%

1.4million

27%

0.6millon 12%

3

Participation Rates by Program

84%71%

0%

20%

40%

60%

80%

100%

Medicaid CHIP

Per

cent

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

4

Medicaid/CHIP Participation Rates by Division

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

90%83%

88% 84%77%

85%74% 74%

83% 81%

0%

30%

60%

90%

New E

ngland

Mid

dle A

tlantic

East N

orth C

entra

l

Wes

t North

Cen

tral

South A

tlantic

East S

outh C

entra

l

Wes

t South

Cen

tral

Mounta

in

Pacifi

c

United S

tate

s

Per

cen

t

5

Characteristics of Uninsured Eligible Children by MSA and Region

Region

13%14%

24%

49%

Northeast Midwest South West

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

MSA

83%

16%

0.8%

MSA Non-MSA Unidentified

6

Share of Low-income Uninsured Children Living in Rural Areas

Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL. Rural is defined as not in metro area.

26.0%

9.9%

30.5%

3.4%

10.1%

13.3%

27.8%

20.1%

17.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

AL IL LA MA NY UT VA WI Nation

7

Characteristics of Uninsured Eligible Children by Age and Family Poverty

Age

32%

33%

35%

0 to 5 6 to 12 13 to 18

Family Income Relative to FPL

51%40%

8%

0.6%

<100% 100-199% 200-299% 300%+

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

8

Share of 13-18 year olds Among Low-income Uninsured Children

Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.

39.0%

45.4%46.8%

44.6%

27.3%

42.3%40.4%

39.1%39.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

AL IL LA MA NY UT VA WI Nation

9

Characteristics of Uninsured Eligible Children by Family Type and Parental Medicaid Eligibility

Family Type

42%

39%

19%

1 Parent

2 Parents

Children not living with parents

Parental Medicaid Eligibility

48%33%

19%

No eligible uninsured parents

Has an eligible uninsured parent

Not residing with parents

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

10

Characteristics of Uninsured Eligible Children by Citizenship and Race/Ethnicity

Citizenship

23%

56%

17%

4%

Citizen with non-citizen parentsCitizen with citizen parentsCitizen not residing with parentsNon-citizen

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

Race/Ethnicity

36%

18%

39%

7%

White Black Hispanic Asian/Other

11

Racial and Ethnic Composition of Uninsured Eligible Children by Region

0%

20%

40%

60%

80%

100%

Northeast Midwest South West

Census Region

Pe

rce

nt Asian/Other

Hispanic

Black

White

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

12

Racial/Ethnic Composition of Low-income Uninsured Children

Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.

11.4%

38.1%

8.2%19.6%

32.1%43.3%

24.7% 25.1%

42.8%

47.0%

29.8%

40.4%

58.0% 34.3%

47.3%

40.1%

57.6%34.1%

34.6%25.2%

47.6%

8.1%21.2%

3.0%

27.0%

8.5% 14.9%

6.1% 5.2% 3.1%14.2% 11.6%

4.8% 6.6% 7.3% 6.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

AL IL LA MA NY UT VA WI Nation

Hispanic White Black or African American Asian/Other

13

Share of Low-income Uninsured Children who Have Moved Within the Last 12 Months

Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.

30.4%

24.4%

26.6%

33.1%

22.7%

31.4%

26.4% 26.0% 26.2%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

AL IL LA MA NY UT VA WI Nation

14Source: Urban Institute Analysis of the American Community Survey

15

Source: Urban Institute Analysis of the American Community Survey Source: Urban Institute Analysis of the American Community Survey

16

Health Insurance among Low-Income Children (0-18) by Parish in Louisiana: Share of State's Total Uninsured and Rate and Rank for Uninsurance, 2008

Geography

Distribution of Uninsured Children in Louisiana

Insurance Status

Private Coverage Public Coverage Uninsured

RateRank

RateRank

RateRank

(1 to 11) (1 to 11) (1 to 11)

Louisiana 78,158 (100%) 34.70% - 59.10% - 10.30% -

Parish  

Caddo 3,071 (3.9%) 42.00% * 10 56.70% 3 6.10% * 3

Calcasieu 2,605 (3.3%) 23.50% * 1 72.00% * 10 9.20% 8

East Baton Rouge 4,421 (5.7%) 33.00% 6 63.20% 8 7.60% 4

Jefferson 6,677 (8.5%) 31.60% 5 61.50% 6 10.40% 9

Lafayette 459 (0.6%) 28.30% 3 72.80% * 11 2.30% * 1

Orleans 4,682 (6.0%) 31.00% 4 56.10% 2 15.50% 11

Ouachita 3,446 (4.4%) 34.80% 7 57.20% 4 12.60% 10

Rapides 1,370 (1.8%) 40.50% 9 57.30% 5 5.50% * 2

St. Tammany 1,520 (1.9%) 26.20% 2 67.20% 9 8.30% 6

Tangipahoa 2,167 (2.8%) 39.20% 8 62.20% 7 8.60% 7

Terrebonne 1,553 (2.0%) 44.20% 11 49.70% 1 8.20% 5

TOTAL: 29,005 (37.1%)

Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series IPUMS).

Note:* rates indicate significant differences from the state mean at the .10 level.Public coverage is defined as having coverage from Medicare, Medicaid, or any government assistance plan for low-income or disabled individuals, and VA. Private coverage is defined as employer/union provided, directly purchased, and TRICARE/military. Health insurance coverage types are not mutually exclusive.

Parishes are areas that are defined by the Missouri Census Data Center.

17

Perceptions of and Barriers to Enrollment in Medicaid/CHIP

45%55% 50% 51%

84% 95% 91%

Heard ofMedicaid or

CHIP

ThinksMedicaid/CHIP

is a GoodProgram

Would EnrollChild if Eligible

Does Not ThinkChild Is Eligible

Does Not KnowHow to EnrollChild In Public

Coverage

ThinksMedicaid/CHIP

EnrollmentProcess is

Difficult

Does Not KnowWhere to Get

MoreInformation

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

18

Participation of Low-Income Families with Uninsured Children in Other Public Programs

13%5% 3%

66%

16%32%

53%

School Lunch Women,Infants and

ChildrenProgram

Food Stamps SSDI HousingAssistance

TANF At Least OneProgram

Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.

19

Among various groups of uninsured children, the estimated percentage whose families filed federal income tax returns: 2004

90.7% 87.2% 94.5% 89.4%

9.3% 12.8% 10.6%

5.5%

0%

25%

50%

75%

100%

All Eligible forMedicaid

Eligible forSCHIP

Eligible forEither Program

Families filed returns Families did not file

Source: Dorn, S., B. Garrett, C. Perry, L. Clemans-Cope, and A. Lucas. “Nine in Ten: Using the Tax System to Enroll Eligible, Uninsured Children into Medicaid and CHIP.” Urban Institute. 2009.

20

Conclusions

Prospects are favorable for further reducing the number of eligible uninsured children;

But public programs face a number of challenges closing coverage gaps;

Future progress will depend on state and federal policy choices and resources related to Medicaid and CHIP.