CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. VIII. How Well Medicaid and CHIP Meet the Health CARE Needs of Low-income Children and Families



  • Children in Medicaid and CHIP experienced better access to care, fewer unmet needs, and greater financial protection than children who were uninsured. Similarly positive results were found when comparing the health care experiences of Medicaid enrollees to those of uninsured children.50
  • Compared to children with private insurance, CHIP enrollees were more likely to have access to dental benefits and much less likely to report financial burdens and stress in meeting their child’s health care needs. However, they were less likely than children with private insurance to have either a regular source of medical care or nighttime or weekend access to a provider at that source of care.
  • The care experiences of Medicaid enrollees were similar to those of privately insured children who later enroll in Medicaid. One exception is that Medicaid enrollees were less likely to have a preventive care visit.
  • Nearly all parents of CHIP enrollees (96 percent) reported feeling confident that their child will be able to get needed health care and a large share of children enrolled in CHIP (86 percent) had seen a doctor or health professional in the last year.
  • Despite relatively high rates of contact with providers in outpatient settings, nearly one in four CHIP enrollees had an unmet need for health care, and many children were not receiving recommended preventive care.
  • Medicaid enrollees had similar access and use experiences as CHIP enrollees, but had higher rates of emergency department visits, hospitalization, and unmet need.

Having CHIP or Medicaid coverage eases entry into the health care system and is an important part of reducing health care barriers and achieving good health outcomes. However, coverage alone does not guarantee that a child will get the care they need and that the content of care received aligns with recommended standards. Other important factors include the family’s ability to find and obtain appointments with health care providers when services are needed, financial burden associated with accessing care, and care experiences with providers. When services are not available, affordable, and/or acceptable to the patient or family, unmet health care needs and delays in the diagnosis and treatment of health care problems can arise.

In the first section of the chapter we present findings on a wide range of health care access and use measures among CHIP and Medicaid enrollees, including access to a regular source of care or provider; type of usual source of care; receipt of primary medical and oral health care, specialist and mental health care, and other services; oral health care access and use; patient-centeredness of care received; unmet needs; and parental perceptions of coverage and financial burden of their child’s health care. We then describe how access and use varied across enrollee subpopulations defined by demographic and health characteristics of the child or their family and across states. The final section of the chapter presents findings from the impacts analysis, examining how access to care and care experiences under CHIP and Medicaid compare to private coverage and being uninsured.

50 Throughout this chapter, CHIP includes both Medicaid expansion and separate CHIP components.

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