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The U.S. Census Bureau’s 2000 figures show there is near universal availability to health care coverage available for low-income children. Now it’s a matter of making sure those who are eligible are properly enrolled. Recent expansions in Medicaid coverage for children and state health insurance programs for them are responsible for the high coverage numbers.
The analysis data — from the Center on Budget and Policy Priorities — show that 94% of all uninsured children with family incomes below twice the poverty line, currently $28,300 for a family of three, qualify for Medicaid or a separate state child health insurance program supported by Children’s Health Insurance Program (CHIP) funds. In 1999, there were 7.1 million low-income children in the United States, and 6.7 million were eligible for child health insurance using current state eligibility standards.
The number of children covered through programs supported with CHIP funds more than doubled in 1999, reaching 1.8 million in December 1999. In addition, the total number of uninsured children in the United States fell by more than 1 million between 1998 and 1999, in part because of increased enrollment of low-income children in publicly funded programs.
Study author Matthew Broaddus, a health research assistant with the center, tells State Health Watch that because 94% of uninsured low-income children are eligible for Medicaid or a state child health program, the nation has largely solved the problem of making low-income children eligible for health insurance. What remains is the challenge of raising enrollment rates among children who are eligible for coverage but remain unenrolled and uninsured.
Mr. Broaddus says many low-income children apparently have not been enrolled because of administrative or other barriers. "The findings of this report suggest the federal government and the states need to take additional steps to implement simpler, more effective enrollment procedures. If the opportunity that the eligibility expansions has created is to be realized more fully, low-income families — especially working families — will need both to be more aware of their children’s eligibility for health insurance programs and to be able to enroll their children without facing the burdensome and time-consuming paperwork and office visit requirements that low-income working parents can encounter."
According to the study, Census Bureau data show there has been progress in recent years in increasing insurance coverage among near-poor children, those with incomes between 100% and 200% of the poverty line, but that coverage has deteriorated for children below 100% of the poverty line. Among poor children, Medicaid coverage has fallen since 1995, the year before the federal welfare law was enacted, and the proportion of children who are uninsured has increased. Mr. Broaddus says the drop largely is a result of the sharp reductions in welfare caseloads and ensuing problems in assuring that low-income children and families leaving welfare retain the insurance coverage for which they qualify.
Three measures before Congress that could have increased enrollment by eligible children would:
1. give states the option to allow schools and other organizations to determine "presumptive eligibility" for Medicaid for low-income children;
2. make it easier for welfare-to-work families to retain their health insurance during the transition;
3. allow states to restore coverage to legal immigrant children and pregnant women.
Mr. Broaddus tells SHW he thinks there is some interest in extending transitional Medicaid and in allowing presumptive eligibility, particularly through school lunch programs. In addition to potential federal action, states could take these steps to eliminate barriers to enrollment:
• simplify application and redetermination procedures, ensuring that questions asked are only those that are required, are clear, and do not have undue verification requirements;
• make Medicaid and state CHIP policies and procedures similar;
• expand application sites, stationing workers in settings such as clinics and hospitals and providing grants to community-based organizations to help complete applications;
• use school lunch information to help identify eligible children in need of coverage;
• expand eligibility for low-income parents.
"The nature of the programs available to children has changed," Mr. Broaddus says. "States need to send a new message that children can be eligible even if their families are not receiving welfare. The eligibility threshold has expanded with CHIP but many working parents still think they’re not eligible." He adds that states have gotten caught up in the fact that they can expand coverage to parents.
[For more information, contact Matthew Broaddus at (202) 408-1080.]