CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. III. Role of Medicaid and CHIP Coverage in Declining Uninsurance Among Children

08/01/2014

KEY FINDINGS

  • Medicaid and CHIP have succeeded in reaching the target population of uninsured children and have contributed greatly to the reduction in uninsurance among low-income children from 25 percent in 1997 to 13 percent in 2012.
  • During the same period, uninsurance rates rose among adults, who were less likely to qualify for Medicaid and CHIP.
  • All racial and income groups experienced gains in coverage, but the gains have been particularly striking among Hispanic children.
  • Participation in Medicaid and CHIP among eligible children increased nationwide from 82 percent in 2008 to 88 percent in 2012; by 2012, 21 states had achieved participation rates of 90 percent or higher while just 5 states had rates of 80 percent or lower.
  • The number of children eligible for Medicaid or CHIP yet uninsured fell from 4.9 to 3.7 million between 2008 and 2012, and 68 percent of all remaining uninsured children are eligible for Medicaid or CHIP.

Previous research has documented substantial declines in uninsurance among low-income children following CHIP’s implementation. Those declines stand in contrast, sometimes sharply, with uninsurance trends for low-income parents and other groups not eligible for the program (Rosenbach et al. 2007; Choi, Sommers, and McWilliams 2011; Howell and Kenney 2012; Blavin et al. 2012a). Studies also show that CHIP expansions have contributed to a reduction in racial and ethnic disparities in coverage among low-income children (Shone et al. 2005; Currie et al. 2008; Choi et al. 2011; Blavin et al. 2012b; Coyer and Kenney 2013; Kenney, Coyer, and Anderson 2013).

In this chapter, we present coverage trends since CHIP’s enactment, including trends in the proportion of children without health insurance. We use a consistent time series of data from the Current Population Survey Annual Social and Economic Supplement (CPS-ASEC), the most widely cited source of information about health insurance coverage; the CPS-ASEC covers the 15-year period—1997 through 2012— since CHIP’s enactment. We also include in this chapter an analysis of data from the ACS for 2008 and 2012 to show changes over time as well as variation across states and key subpopulations in the rate of Medicaid and CHIP participation among eligible children. Overall, the findings suggest that Medicaid and CHIP have succeeded in reaching the target population of uninsured children and have contributed greatly to the reduction in uninsurance among low-income children from 25 percent in 1997 to 13 percent in 2012.

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