On May 31, the Urban Institute released a brief examining health coverage challenges for children under the national health care reform law.  The authors found that approximately 20 million children live in family situations that could create problems accessing health coverage due to eligibility variations within families.  Additionally, the brief notes that nearly 28 million children live apart from at least one parent, presenting additional coverage complexities.  The authors suggest that the U.S. Department of Health and Human Services (HHS) tailor regulations such that children can maximize health coverage under health reform.

From the report:

The Affordable Care Act (ACA) will expand health insurance coverage options for many children and their families. The Medicaid expansion will extend eligibility to many individuals, and federal subsidies to purchase coverage in the health insurance exchanges will improve the affordability of coverage for low-and moderate-income families. To further encourage a reduction in uninsurance, the law also includes an individual requirement to obtain qualifying coverage that applies to most Americans. The ACA will improve accessibility and affordability of coverage for many Americans, but special attention may be required during implementation to ensure that children (age 0 to 18) in particularly complex coverage situations benefit from reform.

Full Report: Addressing Coverage Challenges for Children Under the Affordable Care Act (PDF | 323 KB)

Urban Institute. (2011). Addressing coverage challenges for children under the Affordable Care Act. McMorrow, S., Kenney, G., and Coyer, C. 

On May 31, the Urban Institute released a brief offering strategies to address children's health coverage challenges under the national health care reform law.  The authors found that approximately 20 million children live in family situations that could create problems accessing health coverage due to eligibility variations within families.  Additionally, the brief notes that nearly 28 million children live apart from at least one parent, presenting additional coverage complexities.  The authors suggest that the U.S. Department of Health and Human Services (HHS) tailor regulations such that children can maximize health coverage under health reform.

From the report:

The Affordable Care Act (ACA) will expand health insurance coverage options for many children and their families. The Medicaid expansion will extend eligibility to many individuals, and federal subsidies to purchase coverage in the health insurance exchanges will improve the affordability of coverage for low-and moderate-income families. To further encourage a reduction in uninsurance, the law also includes an individual requirement to obtain qualifying coverage that applies to most Americans. The ACA will improve accessibility and affordability of coverage for many Americans, but special attention may be required during implementation to ensure that children (age 0 to 18) in particularly complex coverage situations benefit from reform.

Full report: Addressing Coverage Challenges for Children Under the Affordable Care Act (PDF | 323 KB)

Urban Institute.  (2011).  Addressing coverage challenges for children under the affordable care act.  McMorrow, S., Kenney, G. and Coyer, C.

On April 5, the U.S. Government Accountability Office (GAO) released a report examining children’s care coordination under Medicaid and the Children’s Health Insurance Program (CHIP).  The report also examines the extent to which mandatory state reports to the Centers for Medicare & Medicaid Services (CMS) reflect the provision of services to children enrolled in those health programs.  Using data from two nationally representative 2007 surveys, the GAO notes that 37 percent of children enrolled in Medicaid and CHIP failed to receive needed care coordination.  In addition, the authors highlight that 12 percent of children in the two health programs had difficulty accessing needed care, tests, or treatments.  The GAO posits that states’ annual reports provide an incomplete assessment of children’s coverage because of reporting errors, missing information, and lack of detail.  The GAO proposes improvements to the state reporting process, particularly designed to differentiate between managed care and fee-for-service (FFS) care.

From the report:

Medicaid and the Children’s Health Insurance Program (CHIP)—two joint federal-state health care programs for low-income families and children—play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have health care conditions that could warrant care from primary care or specialist providers. At the same time, a significant number of children in Medicaid and CHIP may not be receiving basic preventive care, which these programs generally cover. For example, we reported in 2009 that, on the basis of parents’ reports in national surveys, about 40 percent of children in Medicaid and CHIP had not had a well-child checkup over a 2-year period.

Full Report: Medicaid and CHIP: Reports for Monitoring Children’s Health Care Services Need Improvement (PDF | 1.21 MB)

U.S. Government Accountability Office. (2011). Medicaid and CHIP: reports for monitoring children's health care services needs improvements.

This brief from the Urban Institute discusses options for enhancing mental and physical health care and related services for parents through Medicaid and CHIP programs. 

From the report:

Many young children have developmental or behavioral problems that could be addressed or even prevented with the right early response but that are not identified or treated before entering kindergarten, compromising children’s ability to perform up to their potential in school and leading to more costly health and special education interventions later. Because the quality of parenting is so critical to young children’s development, parental or family difficulties— including maternal depression and other parental mental health and medical problems—can endanger children’s development. In these situations, treating parents may be crucial to getting children’s development back on track. Yet, for many reasons, parents often do not receive needed medical or mental health care or other supportive services.  

Full Report: Meeting Parents’ Health and Mental Health Needs through Medicaid and CHIP So Children Can Thrive (PDF | 346 KB) 

Urban Institue. (2011). Meeting parents' health and mental health needs through Medicaid and CHIP so children can thrive. Golden, O. and Fortuny, K. 

On March 15, the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its first annual Report to the Congress on Medicaid and CHIP.  The report found that Medicaid covered 68 million individuals in FY2010, with state and federal spending totaling $406 billion, or 8.1 percent of federal outlays.  In addition, MACPAC determined that the Children’s Health Insurance Program (CHIP) covered 8 million children in FY2010 at a total cost of $11 billion.  Finally, the report also notes that the  Substance Abuse and Mental Health Services Administration (SAMHSA) determined that Medicaid financed 25 percent of behavioral health treatment in 2003.

From the report:

Medicaid and the State Children’s Health Insurance Program (CHIP) are sources of health care coverage for 76 million people, almost one quarter of the population. Medicaid finances health care and related services for more than 30 million low-income children, more than 10 million low-income persons with disabilities, and 6 million low- income seniors with Medicare. CHIP finances health coverage for 8 million uninsured children in families with moderate incomes above Medicaid eligibility levels.

This is the first report of the Medicaid and CHIP Payment and Access Commission (MACPAC) to the Congress. The purpose of this initial report is to contribute to a better understanding of the Medicaid and CHIP programs, their roles in the U.S. health care system, and the key policy and data issues to be addressed. This first report also sets out an analytic framework that serves as the foundation for the Commission’s future work with respect to access and payment. Also included in the Report is a compilation of Medicaid and CHIP program information, including state-specific information about program enrollment, spending, eligibility levels, Medicaid benefits covered, and the federal medical assistance percentage (FMAP). This section of the Report, called MACStats, will be a standing supplement in all Commission reports to the Congress.

Full Report: MACPAC: Report to the Congress on Medicaid and CHIP 

Medicaid and CHIP Payment and Access Commission. (2011). Report to the Congress on Medicaid and CHIP.

On March 10, Kaiser Family Foundation released a report examining Children’s Health Insurance Program (CHIP) enrollment data through 2009.  Outlining national and state-level trends, the report found that CHIP enrollment exceeded 5 million for the first time ever in December 2009, a 4.5 percent increase from December 2008.  The authors note that the CHIP enrollment growth rate grew more quickly between 2006 and 2008, attributing the subsequent decline to increased child Medicaid eligibility.  Finally, KFF found that state officials expressed greater certainty about the future of CHIP following the enactment of the Children’s Health Insurance Program Reauthorization Act of 2009.

From the report:  

The Children’s Health Insurance Program (CHIP), together with Medicaid, provides health coverage for low and moderate income children. Medicaid and CHIP play a central role in proving coverage to millions of children who would otherwise be uninsured because they lack affordable coverage options, particularly during economic downturns. At the time of this enrollment snapshot, states had more certainty about federal CHIP financing due to the Children’s Health Insurance Reauthorization Act of 2009 (CHIPRA) that was enacted in March 2009. The legislation also included incentives for states to find and enroll eligible children in Medicaid and CHIP, and to simplify and streamline the enrollment processes for these programs. However, states were also facing fiscal challenges as a result of the recession that started in December 2007, two years earlier. The enactment of national health reform that extended CHIP funding through 2015 and continues the program through 2019 was not enacted until March 2010 (after the time period for this data snapshot).

Full Report: CHIP Enrollment: December 2009 Data Snapshot (PDF | 570 KB) 

Kaiser Family Foundation. (2011). CHIP enrollment: December 2009 data snapshot.