Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why?

Abstract

Objective: To assess how many uninsured children are eligible for coverage through Medicaid or the Children's Health Insurance Program (CHIP) but not participating and examine the reasons low-income uninsured children are unenrolled.

Methods: Medicaid/CHIP eligibility and participation are estimated for a sample of over 1.4 million children in the 2008 and 2012 American Community Survey. Medicaid/CHIP experience and enrollment barriers are examined for 2300 uninsured children in families with incomes below 200% of the federal poverty level in the 2011-2012 National Survey of Children's Health.

Results: Despite increases in the number eligible for Medicaid or CHIP between 2008 and 2012, participation rose nationwide by 6 percentage points; by 2012, 21 states and the District of Columbia had participation rates for children of 90% or higher. The number of eligible but uninsured declined from 4.9 to 3.7 million, but 68% of uninsured children in 2012 qualified for Medicaid or CHIP. Interest in enrolling uninsured children in Medicaid or CHIP is high (more than 90% of parents say they would enroll their child), but despite the high rates of prior enrollment, many families had knowledge gaps and perceived difficulties with enrollment.

Conclusions: Addressing enrollment/retention barriers and raising Medicaid/CHIP participation in low-performing states hold promise for reducing the number of eligible but uninsured children given the diverse set of states with high participation and the high expressed interest in enrolling children.

Keywords: CHIP; Medicaid; child; children's health care access; insurance coverage.