Children's Health Coverage in the United States
Today, the number of uninsured children is at a historic low. Thanks in large part to Medicaid and the Children's Health Insurance Program (CHIP), which provide comprehensive and affordable health coverage to more than 44 million children (57 percent of all children), and to the new coverage options offered by the Affordable Care Act (ACA), 95 percent of all children have access to health coverage. However, millions of eligible children remain uninsured.
Depending largely on family income, immigration status, and whether or not there is an offer of affordable employer-sponsored coverage, in the post-ACA world, most children will fall into three categories of coverage: Medicaid or CHIP, the new marketplaces, or private (typically employer-sponsored).
Medicaid and CHIP
Medicaid and CHIP provide comprehensive health coverage to millions of people in America — including more than 44 million children under age 19 — who would otherwise be unable to afford health insurance. In FY 2012, Medicaid and CHIP provided health coverage to 57 percent of all children at some point during the year.
A child’s eligibility for these programs is primarily based on family inc-ome and assets. Each state sets its own eligibility standards within broad federal guidelines. The result is a wide variety in coverage from state to state, from a few that meet minimum federal requirements to others that go far beyond to cover more children.
Medicaid is the single largest health insurer for children, providing affordable health coverage to more than 36 million low-income children and children with disabilities. Medicaid covers all medically necessary services children need to survive and thrive. While all children up to 138 percent of poverty were already covered by Medicaid or CHIP, the ACA has made some children who were previously enrolled in CHIP eligible for Medicaid's more comprehensive benefit package. Children in foster care on their 18th birthday are eligible for Medicaid and can continue Medicaid coverage to age 26. In addition, the ACA also makes medical coverage available to millions of low-income parents in states that have implemented the ACA's Medicaid expansion, which in turn encourages them to enroll their children in health coverage.
CHIP provides child-appropriate health coverage to more than 8 million children in working families across America. Created specifically for children, CHIP’s benefits and provider networks are designed to ensure children have access to child-appropriate services, providers, specialists, and facilities. Cost-sharing for CHIP (when states choose to apply it) is affordable for families. States cover children in CHIP through Medicaid, a stand-alone separate CHIP program or a combination approach. The ACA maintained CHIP until 2019, fully funding it through 2015.
The Affordable Care Act (ACA)’s Additional Supports
The ACA has a significant impact on children with private insurance coverage too. Insurers are no longer able to refuse to cover children with pre-existing conditions, revoke coverage when a child gets sick or place annual or lifetime caps on coverage. Today all “Bright Futures” services — the standard of pediatric well-child and preventive coverage recommended by the American Academy of Pediatrics– are now covered for children in public and private insurance without a co-payment.