HHS Urges Children's Medicaid, CHIP Coverage

Recently released data from the Census Bureau shows that the number of uninsured children in the U.S. decreased from 8.1 million in 2007 to 7.3 million in 2008—the lowest since 1987. But efforts still need to be used to reach as many as 65% of  (about 4.7 million) of those uninsured children who are eligible for coverage through Medicaid or the Children's Health Insurance Program (CHIP), said participants at a Department of Health and Human Services briefing on enrolling children in the programs.

Among uninsured children, 39% are concentrated in "a relatively small number of populous states"—California, Texas, and Florida, said Genevieve Kenney, a senior health fellow at the Urban Institute and co-author of the report on Medicaid and CHIP that appears on Health Affairs online. A total of 61% of those uninsured children (2.9 million) are concentrated in 10 states.

Overall, in 2008, the national participation rate in either Medicaid or CHIP was 82%, said Kenney. "This level of participation is high relative to what's typically found in other means-tested government programs—which is probably due to the many efforts that states...have made over the last decade to improve enrollment and retention in both Medicaid and CHIP."

"The share of children without health insurance in America is lower than it's ever been before, and that's very good news—that children don't bear the brunt of this economic downturn," said HHS Secretary Kathleen Sebelius at the briefing. "But our work has only begun."

But despite advances that states have made, millions of uninsured children remain who qualify for coverage but are not enrolled. "I'm challenging everyone, from my state and federal counterparts, to local governments and community-based organizations, to health centers and school districts, to faith-based groups and Indian tribes, to take this conversation about children?s coverage to the next level—to find and enroll those five million kids," Sebelius said.

As part of the CHIP Reauthorization Act passed last year and the Affordable Care Act, "we are investing $120 million in innovative state and local outreach efforts," Sebelius added. "We don't have to write any new laws to do this, and we don't have to pass any bills through Congress. We just need to find the young people and get them enrolled."

The study confirms that the states "have been doing a good job" enrolling children," Sebelius said. But the current participation rates have been found to vary greatly across states—from lows of 55.4% in Nevada and 66.2% in Utah to highs of 95.4% and 95.2% respectively in the District of Columbia and Massachusetts, Also, Hawaii, Maine, Massachusetts, Vermont, and the District of Columbia had participation rates of 91% or higher.

While Arkansas, Kentucky, Louisiana, Michigan, New York, and West Virginia had rates of 88% to 90%, a total of 13 states had participation rates that fell below 80%: Alaska, Arizona, Colorado, Idaho, Florida, Montana, Nevada, North Dakota, Oregon, South Carolina, Texas, Utah, and Wyoming.

The data "will help us to focus our efforts and our grant funding where they are most needed," Sebelius said. "We now have a much better sense of where most uninsured children live, and which communities may need more help."

Among other facts listed in the Health Affairs article are:

• The vast majority of uninsured children (88.2 %) come from families where at least one parent is working.

• 71% of uninsured children in the U.S. have family incomes below 200% of the Federal Poverty Level ($36,620 for a family of three in 2009).

• Among uninsured children living with a parent, nearly 60% live in two?parent households

• A majority of uninsured children (88.2%) come from families where at least one parent is working.

• 71% of uninsured children in the U.S. have family incomes below 200% of the Federal Poverty Level (or $36,620 for a family of three in 2009).