Issues in Developing Programs for Uninsured Children: A Resource Book for States. 1. Age


Age was initially identified as an important eligibility requirement, particularly for states establishing programs independent of Medicaid. The determination of the target population (i.e., the decision to serve children only versus all uninsured residents of the state) is a decision central to the structure of the program and consequently influences future program decisions. Several states suggested that as children are relatively inexpensive to insure, funds may be more effectively utilized by providing coverage for and services to younger children first, and then to consider establishing or expanding a program to insure more costly adults. States must also consider the cohort of children which they plan to insure, as this may impact total enrollment and, therefore, the scope and breadth of services to be provided by the program. States opting to implement Medicaid expansions have determined age eligibility by either utilizing or expanding the current standards.

Most states that have developed separate programs have established unique age eligibility standards.

  • Programs in Colorado, Pennsylvania and New York initially limited eligibility to children under age 13.
  • Due to low enrollment, budget surpluses and new funding, eight of the nine states now cover children up the age 18.
  • The remaining state, Colorado, will be expanding coverage up to age 18 starting in July, 1998, when the current Colorado Children’s Health Plan (CCHP) is replaced by the new Children’s Basic Health Plan (CBHP).