Analysis of Children's Health Insurance Patterns: Findings from the SIPP. Conclusion

05/12/1999

Examining the dynamics of health insurance coverage among children tells us much about the magnitude of the task of insuring the uninsured. While policymakers and researchers tend to focus on the number of children who are without insurance at any one time, children who experience one or more months without insurance over the course of a two-year period are more than double this number. Most children who become uninsured remain uninsured for less than six months at a time, so growth in the number of uninsured children has remained modest. Nevertheless, policymakers' well-warranted concerns about the difficulty of enrolling a high proportion of eligible children--especially those who have not participated in Medicaid previously--bring the problem into focus. Turnover in the population of uninsured children implies that outreach efforts will have to continue at a high level in order to achieve and maintain strong participation in Medicaid and CHIP.

Retention of children who have already enrolled in Medicaid or CHIP emerges as a potentially important policy issue. More than half of the children who leave Medicaid are uninsured the next month, and such children account for two-fifths of the newly uninsured. Why do they leave Medicaid, and if access to insurance continues to be a need, what can be done to keep them enrolled?

Despite a widespread perception to the contrary, participation in Medicaid by eligible children with no other insurance was quite high before welfare reform, and many of those who appeared to be uninsured and eligible for Medicaid were actually in transition--often to Medicaid. But participation rates were lifted by the high proportion of cash assistance recipients. As this group declines in importance the historically much lower participation rates of other groups of eligibles may become more typical. As CHIP extends affordable health insurance coverage to increasingly more children, the greatest challenge for policymakers is to ensure that no child who needs this coverage is denied it.

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