Genevieve Kenney, Senior Fellow Health Action 2010 Families USA January 28, 2010 [email protected]/(202) 261-5568 Covering Children in Medicaid/ CHIP: Who Remains Uninsured And What Are The Prospects for Covering More? TH E U R B A N IN STITU TE TH E U R B A N IN STITU TE
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Genevieve Kenney, Senior Fellow Health Action 2010 Families USA January 28, 2010 [email protected]@urban.org /(202) 261-5568 Covering Children in.
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Eligibility of Uninsured Children for Medicaid/CHIP Coverage, 2007
3.2 million
41%
1.8million
23%
2.8millon 36%
Eligible forMedicaid
Eligible forCHIP
Ineligible
7.8 million uninsured children
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
Note: Uninsured estimate reflects an adjustment for the underreporting of public coverage on the CPS.
5.2 million low-income uninsured children
64% of all uninsuredchildren are eligible
88% of all low-incomeuninsured children are eligible
3.2 million
61%
1.4million
27%
0.6millon 12%
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Participation Rates by Program
84%71%
0%
20%
40%
60%
80%
100%
Medicaid CHIP
Per
cent
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Medicaid/CHIP Participation Rates by Division
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
90%83%
88% 84%77%
85%74% 74%
83% 81%
0%
30%
60%
90%
New E
ngland
Mid
dle A
tlantic
East N
orth C
entra
l
Wes
t North
Cen
tral
South A
tlantic
East S
outh C
entra
l
Wes
t South
Cen
tral
Mounta
in
Pacifi
c
United S
tate
s
Per
cen
t
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Characteristics of Uninsured Eligible Children by MSA and Region
Region
13%14%
24%
49%
Northeast Midwest South West
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
MSA
83%
16%
0.8%
MSA Non-MSA Unidentified
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Share of Low-income Uninsured Children Living in Rural Areas
Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL. Rural is defined as not in metro area.
26.0%
9.9%
30.5%
3.4%
10.1%
13.3%
27.8%
20.1%
17.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
AL IL LA MA NY UT VA WI Nation
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Characteristics of Uninsured Eligible Children by Age and Family Poverty
Age
32%
33%
35%
0 to 5 6 to 12 13 to 18
Family Income Relative to FPL
51%40%
8%
0.6%
<100% 100-199% 200-299% 300%+
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Share of 13-18 year olds Among Low-income Uninsured Children
Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.
39.0%
45.4%46.8%
44.6%
27.3%
42.3%40.4%
39.1%39.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
AL IL LA MA NY UT VA WI Nation
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Characteristics of Uninsured Eligible Children by Family Type and Parental Medicaid Eligibility
Family Type
42%
39%
19%
1 Parent
2 Parents
Children not living with parents
Parental Medicaid Eligibility
48%33%
19%
No eligible uninsured parents
Has an eligible uninsured parent
Not residing with parents
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Characteristics of Uninsured Eligible Children by Citizenship and Race/Ethnicity
Citizenship
23%
56%
17%
4%
Citizen with non-citizen parentsCitizen with citizen parentsCitizen not residing with parentsNon-citizen
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
Race/Ethnicity
36%
18%
39%
7%
White Black Hispanic Asian/Other
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Racial and Ethnic Composition of Uninsured Eligible Children by Region
0%
20%
40%
60%
80%
100%
Northeast Midwest South West
Census Region
Pe
rce
nt Asian/Other
Hispanic
Black
White
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Racial/Ethnic Composition of Low-income Uninsured Children
Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.
11.4%
38.1%
8.2%19.6%
32.1%43.3%
24.7% 25.1%
42.8%
47.0%
29.8%
40.4%
58.0% 34.3%
47.3%
40.1%
57.6%34.1%
34.6%25.2%
47.6%
8.1%21.2%
3.0%
27.0%
8.5% 14.9%
6.1% 5.2% 3.1%14.2% 11.6%
4.8% 6.6% 7.3% 6.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
AL IL LA MA NY UT VA WI Nation
Hispanic White Black or African American Asian/Other
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Share of Low-income Uninsured Children who Have Moved Within the Last 12 Months
Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS).Note: Low-income is defined as incomes less than 300% of FPL.
30.4%
24.4%
26.6%
33.1%
22.7%
31.4%
26.4% 26.0% 26.2%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
AL IL LA MA NY UT VA WI Nation
14Source: Urban Institute Analysis of the American Community Survey
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Source: Urban Institute Analysis of the American Community Survey Source: Urban Institute Analysis of the American Community Survey
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Health Insurance among Low-Income Children (0-18) by Parish in Louisiana: Share of State's Total Uninsured and Rate and Rank for Uninsurance, 2008
Source: Urban Institute analysis of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series IPUMS).
Note:* rates indicate significant differences from the state mean at the .10 level.Public coverage is defined as having coverage from Medicare, Medicaid, or any government assistance plan for low-income or disabled individuals, and VA. Private coverage is defined as employer/union provided, directly purchased, and TRICARE/military. Health insurance coverage types are not mutually exclusive.
Parishes are areas that are defined by the Missouri Census Data Center.
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Perceptions of and Barriers to Enrollment in Medicaid/CHIP
45%55% 50% 51%
84% 95% 91%
Heard ofMedicaid or
CHIP
ThinksMedicaid/CHIP
is a GoodProgram
Would EnrollChild if Eligible
Does Not ThinkChild Is Eligible
Does Not KnowHow to EnrollChild In Public
Coverage
ThinksMedicaid/CHIP
EnrollmentProcess is
Difficult
Does Not KnowWhere to Get
MoreInformation
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Participation of Low-Income Families with Uninsured Children in Other Public Programs
13%5% 3%
66%
16%32%
53%
School Lunch Women,Infants and
ChildrenProgram
Food Stamps SSDI HousingAssistance
TANF At Least OneProgram
Source: Kenney, Cook, and Dubay. “Progress Enrolling Eligible Children in Medicaid/CHIP: Who is Left and What Are the Prospects for Covering More Children?” Urban Institute/Robert Wood Johnson Foundation. 2009.
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Among various groups of uninsured children, the estimated percentage whose families filed federal income tax returns: 2004
90.7% 87.2% 94.5% 89.4%
9.3% 12.8% 10.6%
5.5%
0%
25%
50%
75%
100%
All Eligible forMedicaid
Eligible forSCHIP
Eligible forEither Program
Families filed returns Families did not file
Source: Dorn, S., B. Garrett, C. Perry, L. Clemans-Cope, and A. Lucas. “Nine in Ten: Using the Tax System to Enroll Eligible, Uninsured Children into Medicaid and CHIP.” Urban Institute. 2009.
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Conclusions
Prospects are favorable for further reducing the number of eligible uninsured children;
But public programs face a number of challenges closing coverage gaps;
Future progress will depend on state and federal policy choices and resources related to Medicaid and CHIP.