Today, the number of uninsured children is at a historic low. Thanks in large part to Medicaid and the Children’s Health Insurance Program (CHIP), which provide comprehensive and affordable health coverage to more than 44 million children (57 percent of all children), and to the new coverage options offered by the Affordable Care Act (ACA), 94 percent of all children have access to health coverage. However, many children eligible for Medicaid and CHIP remain uninsured.
Depending largely on family income, immigration status, and whether the family has an offer of affordable employer-sponsored coverage, in the post-ACA world, most insured children will have one of three types of coverage: Medicaid or CHIP, employer-sponsored insurance or ACA marketplace.
Medicaid and CHIP
A child’s eligibility for Medicaid and CHIP is primarily based on family income and assets, set by the states within broad federal guidelines. The result is a wide variety in coverage from state to state, from a few that meet or barely exceed minimum federal requirements to others that go far beyond to cover more children. Medicaid and CHIP provide comprehensive health coverage to millions of people in America—including more than 44 million children under age 19—who would otherwise be unable to afford health coverage.
Medicaid is the single largest health insurer for children, providing virtually no cost health coverage to more than 36 million low-income children and children with disabilities. Medicaid coverage is comprehensive, covering all medically necessary services children need to survive and thrive. The ACA requires states to cover children up to 138 percent of the federal poverty level under Medicaid, but as mentioned above, many states go beyond that to cover children at higher incomes. The ACA also allows children in foster care on their 18th birthday to continue Medicaid coverage to age 26. Importantly, the ACA encouraged states to expand Medicaid to low-income adults, which also increases child health coverage, as insured parents are more likely to have insured children and seek care when they need it.
CHIP provides child-appropriate health coverage to more than 8 million children in working families across America with higher income eligibility than Medicaid. Created specifically for children, CHIP’s benefits and provider networks are designed to ensure children have access to child-appropriate services, providers, specialists, and facilities. Cost-sharing for CHIP (when states choose to apply it) is affordable for families. State CHIP programs may be rolled together with Medicaid, be a stand-alone separate program or some combination of the two. The ACA required states to maintain their CHIP programs without cuts until 2019, but only funded it through 2015. In March 2015 funding for CHIP was extended for an additional two years, through September 30, 2017. To ensure that children do not lose ground, CDF strongly supports preserving, improving and funding CHIP at least until it has been demonstrated that ACA’s marketplaces can guarantee children health coverage that is comparable or better to what they have now in CHIP.
The Affordable Care Act (ACA)’s Additional Supports for Children
The ACA has a significant impact on children with private insurance coverage too. Insurers are no longer able to refuse to cover children with pre-existing conditions, revoke coverage when a child gets sick or place annual or lifetime caps on coverage. Today all “Bright Futures” services—the standard of pediatric well-child and preventive coverage recommended by the American Academy of Pediatrics—are now covered for children in public and private insurance without a co-payment.