Health Care Coverage and Medicaid/CHIP Eligibility for Child Support Eligible Children. Results

07/30/2011

Health insurance coverage of child support eligible children

Exhibit 1 shows the health insurance distribution for all children and for CS eligible children in 2008.  Nearly 60 percent of all children have private coverage compared to 37 percent of CS eligible children.  Just over half of CS eligible children have public coverage however, resulting in an uninsurance rate of 11 percent for CS eligible children compared to 9 percent for all children.

Exhibit 1:
Health Insurance Coverage of Children (0 - 18)

Exhibit 1: Health Insurance Coverage of children (0-18). See exhibit 2 for the data and Appendix table 1.

Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.
Additional details provided in text.  Estimates of uninsured children have been adjusted by the
Urban Institute's Health Policy Center for the underreporting of public coverage on the CPS.
This adjustment has the impact of reducing the number of uninsured by approximately 1 million.
Children who report multiple types of coverage are assigned one type according to the following hierarchy:
Medicaid/CHIP, ESI within household, coverage from outside the household, other public and direct purchase within household.
Private coverage includes ESI, coverage outside the household, and direct purchase.
Public coverage includes Medicaid/CHIP and other public.

Exhibit 2 displays the health insurance coverage distribution of CS eligible children in more detail.  Based on this analysis, approximately 51 percent of CS eligible children have Medicaid/CHIP coverage.  An additional 31 percent of the CS eligible population has private coverage from someone in their household and 6 percent obtain insurance coverage from someone outside the household.  A small proportion of children (1 percent) obtain coverage from other federal sources.  The remaining 11 percent of CS eligible children are estimated to be uninsured.  Supplementary estimates that reflect children reporting both Medicaid/CHIP and private coverage are found in Appendix Table 2.

Exhibit 2:
Health Insurance Coverage of Children (0-18)
  All Children CS Eligibile Children
Private coverage 56% 37%
   Within household 54% 31%
   Outside household 2% 6%
Medicaid/CHIP 33% 51%
Other federal 1% 1%
Uninsured 9% 11%
Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.  Additional details provided in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.  Children who report multiple types of coverage are assigned one type according to the following hierarchy: Medicaid/CHIP, ESI within household, coverage from outside the household, other federal and direct purchase within household.  Private coverage includes ESI, coverage from outside the household and direct purchase.

Distribution of CS eligible children by income and family type

As the high rates of Medicaid/CHIP coverage suggest, the CS eligible population is also a low-income population.  As shown in Exhibit 3, nearly 70 percent of all CS eligible children live in families with incomes below 200 percent of the FPL.  This compares to 45 percent of all children.  Exhibit 4 shows the living arrangements of CS eligible children compared to all children.  Predictably, most CS eligible children (63 percent) live in one-parent families, but 22 percent live in two-parent families and 16 percent live in multi-generational or other family arrangements.[22]

Exhibit 3
Income Distribution of Children (0 - 18)

Exhibit 3: Income Distribution of Children (0-18). See Appendix table 3 for data.

Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under with no parents.
Additional details in text.  Income relative to the federal poverty level (FPL) reflects the income of the health insurance unit (HIU)
and 2008 U.S. Census Bureau poverty thresholds.

Exhibit 4
Family Type Distribution of Children (0-18)

Exhibit 4: Family Type Distribution of Children (0-18). See Appendix 3 for the data.

Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children 18 and under living with only one biological parent and children 14 and under living with no parents.  Additional details in text.
Family type reflects the Census definition of family.  Census family groupings differ from HIUs because they can include family members
who are not part of the nuclear family unit (e.g. grandparents).
* CS eligible children in two-parent families are those living with one biological parent and one step-parent.

Uninsurance rate of CS eligible children

As shown in Exhibit 1, 11 percent of CS eligible children are uninsured.  The uninsurance rate varies by income, however, as shown in Exhibit 5.  Those with incomes below 100 percent of the FPL have the highest uninsurance rate (14 percent) while those with the highest incomes have a much lower rate of uninsurance (4 percent).  Exhibit 6 shows the uninsurance rate by family composition.  Children from one-parent and two-parent families have similar uninsurance rates of approximately 10 percent each, but those living in multigenerational or other family arrangements have uninsurance rates of 20 percent.  Other family arrangements include children living with other relatives and foster children.

Exhibit 5
Uninsurance Rate of CS Eligible Children (0-18) by Income

Exhibit 5: Uninsurance Rate of CS Eligible Children (0-18) by Income. See Appendix table 4 for data.

Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.  Additional details provided in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.  Children who report multiple types of coverage are assigned one type according to the following hierarchy: Medicaid/CHIP, ESI within household, coverage from outside the household, other public and direct purchase within household. Private coverage includes ESI, coverage outside the household, and direct purchase.  Public coverage includes Medicaid/CHIP and other public.

Exhibit 6
Uninsurance Rate of CS Eligible Children (0-18) by Family Type

Exhibit 6: Uninsurance Rate of CS Eligible Children (0-18) by Family Type. See Appendix tables for data.

Source: Urban Institute analysis of the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.  Additional details in text.
Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.  Family type reflects the Census definition of family.  Census family groupings differ from HIUs because they can include family members who are not part of the nuclear family unit (e.g. grandparents).
* CS eligible children in two parent families are those living with one biological parent and one step-parent.

 

Medicaid/CHIP eligibility of CS eligible children

Exhibit 7 indicates that Medicaid/CHIP eligibility is quite high among CS eligible children, with over 70 percent eligible.  This compares to 51 percent of all children.  Eligibility is almost universal for those under 200 percent of the FPL, as shown in Exhibit 8.[23]  Just over 40 percent of those with more moderate incomes (200-299 percent of the FPL) are also eligible and eligibility declines as expected with higher incomes.[24]  With uninsurance rates hovering around 13 percent for those under 200 percent of the FPL (see Exhibit 5), these estimates suggest that Medicaid and CHIP could play significant roles in covering uninsured CS eligible children.

Exhibit 7
Medicaid/CHIP Eligibility of Children (0-18)

Exhibit 7: Medicaid/CHIP Eligibility of Children (0-18). See appendix table for data.

Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the
2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and
children 14 and under living with no parents.  Additional details in text.

Exhibit 8
Medicaid/CHIP Eligibility of Child Support Eligible Children (0-18), by Income

Exhibit 8: Medicaid/CHIP Eligibility of Child Support Eligible Children (0-18), by Income. See appendix table for data.

Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the
2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.
Additional details in text.  Income relative to the federal poverty level (FPL) reflects the income of the health insurance unit (HIU)
and 2008 U.S. Census Bureau poverty thresholds.

Uninsured child support eligible children and their Medicaid/CHIP eligibility

As shown in Exhibit 1, our estimates find that 11 percent of CS eligible children (a total of 2.9 million) were uninsured in 2008.[25],[26]  Exhibit 9 displays our estimates of Medicaid/CHIP eligibility for uninsured children.  Over two-thirds of all uninsured children are eligible for Medicaid/CHIP and our primary finding reveals that 79 percent of uninsured CS eligible children were eligible for Medicaid/CHIP under 2008 rules.  Fully 2.3 million CS eligible children are uninsured despite being eligible for Medicaid/CHIP.[27]  As was the case in the population as a whole, the lowest income uninsured children and those from multi-generational families are the most likely to be eligible for Medicaid/CHIP (see Appendix Table 6).  These results strongly suggest that enrolling all currently Medicaid/CHIP eligible children in these programs would dramatically decrease the uninsurance rate among CS eligible children.  In addition, enrolling this population would make substantial progress towards reducing the uninsurance rate for children more generally.

Exhibit 9
Medicaid/CHIP Eligibility of Uninsured Children (0-18)

Exhibit 9: Medicaid/CHIP Eligibility of Uninsured Children (0-18). See appendix table for data.

Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the
2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.
Additional details provided in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center
for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.

Child support eligible children among all uninsured children

Exhibits 10 and 11 show the distribution of uninsured children by child support and Medicaid/CHIP eligibility.  The CS eligible population represents approximately 40 percent of all uninsured children.  Furthermore, almost one-third of all uninsured children are eligible for both child support and Medicaid/CHIP.[28]  Exhibit 12 focuses on the population of Medicaid/CHIP eligible uninsured children.  These children are the focus of the Secretary’s Challenge: Connecting Kids to Coverage that aims to enroll all uninsured children in the programs for which they are eligible.[29]  Exhibit 12 shows that 47 percent of this population is CS eligible.[30]

 

Exhibit 10:
Child Support (CS) and Medicaid/CHIP Eligibility of All Uninsured Children (0-18)
Child Support and Medicaid/CHIP Eligible Percent
Child Support Eligible 41%
   Medicaid/CHIP eligible 32%
   Not Medicaid/CHIP eligible 9%
Not Child Support Eligible 59%
   Medicaid/CHIP eligible 36%
   Not Medicaid/CHIP eligible 23%
Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the 2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents. Additional details in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.  Estimates of the proportion of children that are CS eligible reflect an overreporting of CS eligible children on the ASEC of up to 14 percent.

Exhibit 11
Medicaid/CHIP and Child Support Eligibility of Uninsured Children (0-18)

Exhibit 11: Medicaid/CHIP and Child Support Eligibility of Uninsured Children (0-18). See appendix table for data.

Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the
2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.
Additional details provided in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center
for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.
Estimates of the proportion of children that are CS eligible reflect an overreporting of CS eligible children on the ASEC of up to 14 percent.

Exhibit 12
Child Support Eligible Children among Medicaid/CHIP Eligible Uninsured Children

Exhibit 12 Child Support Eligible Children among Medicaid/CHIP Eligible Uninsured Children. See appendix tables for data.

Source: Urban Institute Health Policy Center Eligibility Simulation Model, based on data from the
2009 Annual Social and Economic (ASEC) Supplement to the Current Population Survey (CPS).
Note: CS eligible children are children 18 and under living with only one biological parent and children 14 and under living with no parents.
Additional details provided in text.  Estimates of uninsured children have been adjusted by the Urban Institute's Health Policy Center
for the underreporting of public coverage on the CPS.  This adjustment has the impact of reducing the number of uninsured by approximately 1 million.
Estimates of the proportion of children that are CS eligible reflect an overreporting of CS eligible children on the ASEC of up to 14 percent.

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