How Stable Is Medicaid Coverage For Children?

Abstract

We examined Medicaid coverage patterns in five states for children who were covered as of December 2003. Looking back three years, we found that Medicaid was a source of continuous coverage for sizable proportions of children (43-66 percent were covered for two or more years) but a revolving door for others (16-41 percent had gaps). In all states, gaps were short, from two to four months. Continuity implies that states can demand more of the health care system to improve the quality of care; short gaps imply that policies and procedures should be revisited to reduce gaps for eligible children. R e c e n t s t u d i e s h av e d o c u m e n t e d i n s ta b i l i t y in health insurancefor a large proportion of the U.S. population: Approximately eighty-five million (or one in three) Americans were uninsured at some point between 1996 and 1999. During this same four years, more than 40 percent of children experienced a gap in coverage, and nearly half of those were repeatedly or continuously uninsured. These studies have shown that being insured and uninsured are not chronic states; rather, a sizable proportion of the population moves between them.

Insurance + Access != Health Care: Typology of Barriers to Health Care Access for Low-Income Families

“…[12][13][14]16 Other analyses have used vital statistics and Medicaid data to study utilization and coverage patterns. 6,17 Secondary analyses of administrative data are often several steps removed from the real-life experiences of vulnerable families, and studies conducted in physicians' offi ces miss the invisible families who are unable to visit health care facilities. To our knowledge, limited information has been collected directly from families living in poverty about factors affecting access to medical care and how insurance status affects their situations.…”

Massachusetts Health Reform and Access for Children With Special Health Care Needs

“…20 It may also be attributable to the fact that this state had not yet implemented simplifications in Medicaid-CHIP enrollment or renewal, which have been shown to reduce instances of uninsurance for children from low-income families. [46][47][48] However, because Massachusetts had high Medicaid-CHIP eligibility levels and rates of insurance prereform, the remaining uninsured CSHCN might be hard-to-reach subjects or undocumented. 49,50 Because the ACA specifically includes children in the individual mandate and incentivizes states to simplify Medicaid-CHIP enrollment and renewal, reductions in uninsurance may be greater under the ACA than under Massachusetts health reform.…”

Obtaining Health Care Services for Low-Income Children: A Hierarchy of Needs

“…12,13 A majority of these uninsured children qualify for publicly-funded insurance programs, such as Medicaid and the State Children's Health Insurance Programs (SCHIP), but have either lost coverage or become disenrolled due to various barriers. [13][14][15][16] Oregon has a high rate of uninsured children, 13,17 and over 60% of uninsured Oregon children appeared to be eligible for some form of public coverage in 2004-a higher percentage than is estimated for uninsured children nationally. 11,18 As struggles to reauthorize SCHIP continue, [19][20][21][22] Oregon and several other states are focused on enrolling uninsured but eligible low-income children.…”

“…Past research has concluded that most low-income parents are familiar with Medicaid and SCHIP, but restrictive regulations and confusing organizational structures keep public health insurance out of reach for some low-income families and contribute to coverage instabilities for others. 14,17,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Less is known about how parents feel about public insurance offerings and whether they believe that getting and maintaining coverage is worth the effort required. Despite the wealth of evidence linking insurance to better health care outcomes, how much does health insurance matter to poor families?…”

“…14,17,40,42,43 Study methods often include the use of administrative data, claims data, secondary analysis of national surveys, and key informant interviews, all of which are several steps removed from the actual life experiences of poor and underserved families. We collected information directly from lowincome parents about the importance of health insurance and other possible factors affecting access to health care for their children.…”