State Estimates of Uninsured Children, January 1998. Final Report.. Executive Summary

05/17/2000

State estimates of the number and characteristics of uninsured children have attracted growing interest with the passage of legislation establishing the State Children’s Health Insurance Program (SCHIP).The Current Population Survey (CPS), the most widely cited source of data on the uninsured, has been criticized because its state samples are currently inadequate to provide state estimates of uninsured children with sufficient statistical precision to serve policy needs. To produce detailed breakdowns of uninsured children goes well beyond what most of the state samples can support. But while it may be inappropriate to rely on “direct sample” estimation to produce the tabulations that policymakers require, there exist innovative but well-grounded techniques for developing state estimates by the application of statistical procedures that “borrow strength” from other data sources.

This report employs statistical procedures that allow us to (1) make use of the entire national CPS sample in developing estimates for each state and (2) incorporate data from a wide variety of other sources. We apply these procedures to the March 1998 CPS to develop state estimates of the number of uninsured children in January 1998 by poverty level and age. The report also includes illustrative estimates of the number of children simulated to be eligible for Medicaid and the number who would be eligible for coverage under the SCHIP if the September 1999 rules had been in effect in 1997. The resulting tabulations are much more precise than those obtained from the CPS alone, and they can provide state and federal policymakers with baseline information that will be valuable in designing future expansions of SCHIP and in evaluating their progress in reducing the number of children who are without health insurance.

By simulating key features of the Medicaid and SCHIP eligibility provisions by state, we obtained estimates of the number of uninsured children in each state who were eligible for Medicaid and the additional number of uninsured children who would be made eligible for coverage under SCHIP. Nationally, we estimated that out of 11.5 million uninsured children, 4.2 million were eligible for Medicaid and an additional 2.4 million would become eligible for coverage under SCHIP, based on program provisions implemented by September 1999. Thus one-third of the uninsured children who were not already covered by Medicaid would become eligible for coverage under SCHIP. This proportion varied substantially across the states, depending in part on how many children under 200 percent of poverty were already covered under state Medicaid programs and how generously states elected to extend coverage. Six states appeared to be extending coverage to less than 10 percent of the remaining uninsured children in their states while 15 states were extending coverage to more than 40 percent of the remaining uninsured children.

Medicaid coverage is underreported in the CPS, but there are no widely accepted estimates of how many children whose Medicaid coverage is not reported are counted as uninsured.Our estimates include no adjustment for the underreporting of Medicaid, so they almost certainly overstate how many uninsured children are eligible for Medicaid and not enrolled. The estimates of additional uninsured children who would be covered by SCHIP are not affected by this undercount, but children who were actually enrolled in SCHIP in 1997 are excluded from the count of potential new enrollees to the extent that their coverage was reported in the CPS.

The report includes 10 tabulations for each of the 50 states and the District of Columbia. Each tabulation classifies children by six poverty levels and four age groups. Tables are presented for: all children under 19, the number and percent of children uninsured the previous year, total children and uninsured children simulated to be Medicaid-eligible, and total children and uninsured children simulated to be Medicaid- or SCHIP-eligible. Direct sample estimates of all children under 19 and the number and percent of children uninsured the previous year are included among the 10 tabulations to allow comparison with the model-based estimates.