Bolstered by the federal health care reform law, the number of low-income kids getting full health coverage in California continues to grow, as it does in the nation as a whole, a recent study found.
The rate of uninsurance among California’s children dropped from 7.3 percent in 2013 to 5.2 percent in 2014, according to the study, conducted by researchers at the Urban Institute. Among the uninsured were immigrant children living in the country unlawfully, who until recently were ineligible for full coverage under Medi-Cal, California’s version of the federal Medicaid program for people with low incomes.
One reason for the increase in coverage of California’s children is that the state embraced the Affordable Care Act’s expansion of Medicaid to adults with incomes up to 138 percent of the federal poverty level (about $33,500 for a family of four). It was likely a spillover effect, as adults signed up and learned that their kids were eligible, too.
Between 2013 and 2014, the already robust percentage of eligible California children participating in Medi-Cal, rose 3.4 percentage points, from 88.9 percent to 92.3 percent, according to the study.
Not surprisingly, the Urban Institute researchers showed that the biggest coverage increases across the United States occurred in the states that expanded their Medicaid programs. In addition to California, 30 other states and the District of Columbia have adopted the expansion so far.
Nationwide, 91 percent of children who were eligible for Medicaid or the Children’s Health Insurance Program (CHIP) were enrolled in 2014, the first full year of the law’s implementation, according to the study. That was up from 88.7 percent in 2013 and only 81.7 percent in 2008.
CHIP, like Medicaid, is a federal-state health coverage program for low-income residents. CHIP provides coverage for kids whose families earn too much to qualify for Medicaid.
In California, almost all children covered by public insurance receive Medi-Cal. The state once had a separate CHIP program for slightly higher-income kids, but officials merged it with Medi-Cal several years ago.
The national increase in coverage among children eligible for Medicaid and CHIP mirrors changes in the overall uninsurance rate for children, which fell from 7 percent in 2013 to 5.8 percent in 2014, the researchers noted.
They estimated that 4.5 million children younger than 18 are still uninsured. That population varies significantly among states, according to the report: Fourteen states have an uninsurance rate below 4 percent, while in four — Alaska, Arizona, Nevada and Texas — it is above 9 percent.
Given that national coverage rates for children were already high, “I was surprised to see gains to such an extent in 2014, and for that to happen for so many different kinds of kids and in so many different places,” said Genevieve Kenney, co-director of the Urban Institute’s Health Policy Center, who was an author of the study.
In California, the number of uninsured minors is likely to drop even further after a new state law took effect earlier this week allowing low-income immigrant children who are in the country illegally to sign up for full-Medi-Cal benefits. An estimated 170,000 undocumented children in the state can now apply for full health coverage, and advocates are launching enrollment campaigns to help them do so.
Nationwide, children of different ethnic groups, ages and family incomes benefited from coverage gains between 2013 and 2014. But progress has been slower for some groups, including adolescents between the ages of 13 and 18, and Hispanic kids in families with no English-speaking parent(s).
The Urban Institute study used data from the American Community Survey, an ongoing tracking study by the U.S. Census Bureau that includes data on more than 700,000 children ages 18 and younger.
Nearly two-thirds of the 4.5 million children who were uninsured in 2014 were eligible for Medicaid or CHIP, the study found. Many of them had been enrolled in Medicaid at some point in their lives, Kenney said.
“That puts the spotlight on renewal and retention,” Kenney said. States have adopted different strategies to encourage continued coverage. Some have policies that, for example, allow kids to stay enrolled in Medicaid or CHIP for the full year even if their parents’ income or other circumstances change. Others determine whether kids are still eligible for the programs by conducting data checks rather than requiring parents to fill out paperwork.
Kenney said she expects that uninsurance rates for kids improved again in 2015, as more states expanded Medicaid and families enrolled in subsidized insurance on the state marketplaces. This month, Arizona reinstated its CHIP program, after freezing enrollment in 2009, thus extending coverage to more lower income children.