Ringing in a New Year for Children’s Coverage

By Carla Plaza
January 2014

The start of a new year is a time for reflection and making resolutions. A new year also brings renewed hope, and in 2014, many individuals and families will have access to health insurance coverage, perhaps for the first time. Given all the attention to enrollment and coverage due to the roll out of the Affordable Care Act (ACA), we here at NASHP also hope to continue to help states make progress in reducing the number of uninsured children.

According to the Georgetown Center for Children and Families, 5.3 million children were uninsured in 2012. Among these children, Hispanic and American Indian and Alaska Native children are disproportionately represented. The good news is that nearly 93 percent of children have coverage and the uninsured rate among children continues to decline across all racial and ethnic groups. Two public insurance programs have predominantly played a role in this success—Medicaid and the Children’s Health Insurance Program (CHIP). These programs have worked together since 1997 to increase rates of insurance among low-income children.
Despite giving priority attention to eligibility and enrollment system and policy changes required or made optional by the ACA, in 2013 states continued to improve their public health insurance coverage for children. In addition, states made adjustments to their programs to fit with the changing coverage landscape. For example, 16 states eliminated their CHIP waiting period requirements. Of the six states that took up the federal enrollment option to facilitate enrollment of Medicaid-eligible individuals using Supplemental Nutrition Assistance Program (SNAP) data, Arkansas and West Virginia leveraged this strategy to also target eligible but unenrolled children. Kentucky eliminated its five-year waiting period for lawfully residing children and added coverage for substance abuse to its CHIP program. And as we closed out the year, we learned that 23 states received a performance bonus award for improving their children’s coverage programs and increasing Medicaid enrollment.
What will 2014 bring for children’s coverage programs? With the focus shifted to the newly eligible population, who are primarily adults, will we lose site of the substantial progress made over the past 17 years, since CHIP was implemented, to reduce the number of uninsured children? Will the state-based and federally facilitated marketplaces work for children? Will families be able to afford marketplace coverage for spouse and child dependents given how federal rules calculate employee sponsored insurance affordability? What will happen to the Children’s Health Insurance Program? Will the program continue to exist past 2015 when federal funding is scheduled to run out? If funding is appropriated, what changes might Congress make to the program? In a recent blog, Catherine Hess, NASHP’s Managing Director, raised these and other issues on the minds of many child health coverage stakeholders, including state officials and child health advocates.
Especially in the face of these unknowns, continued progress in reducing the number of uninsured children, particularly among children of color, will be important in the new year and beyond. NASHP will build on our longstanding work in the area of children’s coverage. With funding from The Atlantic Philanthropies, we will support the third phase of the Children in the Vanguard network, which brings together state Medicaid and CHIP officials with child health advocates from a diverse group of 14 states to focus on advancing children’s coverage in the context of health reform. This year our network includes seven new states and seven returning states. We also will continue supporting all states’ efforts to implement effective children’s coverage programs, including in addressing the future of CHIP and other policy options for keeping children’s coverage strong, through support from the David and Lucile Packard Foundation.
Through these projects NASHP will continue to support states and share information and resources on emerging issues, promising and best practices, and state strategies for ensuring that children’s coverage remains strong into and beyond 2014. For information on policy issues and options related to children’s coverage and health care reform, visit NASHP’s Children’s Coverage Toolbox.


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