Progress Enrolling Children in Medicaid/CHIP

Who is Left and What are the Prospects for Covering More Children?

According to new coverage estimates released in September 2009, the number of children without health insurance coverage declined by about 800,000 between 2007 and 2008—reaching its lowest level in over a decade. However, despite this progress, an estimated 5 million children are eligible for programs like Medicaid or CHIP, but are not enrolled—falling through the cracks in most states.

This brief by Urban Institute authors Genevieve Kenney, Allison Cook and Lisa Dubay, examines the characteristics of the children who remain uninsured and the prospect for enrolling them in public coverage. While many states have adopted a host of policy changes aimed at increasing participation over the last decade, barriers to enrolling more children still exist. The authors cite research showing over 90 percent of low-income parents say they would enroll their uninsured child if their child was eligible, but around half do not know their child is eligible, do not know how to apply, and/or find the application process difficult.

To close coverage gaps, states may need to (a) undertake targeted outreach efforts aimed at teenagers, Hispanics, and other groups of children with lower than average participation rates, (b) provide additional support for community-based application assistance, (c) broaden their outreach strategies to include parents, and (d) address existing barriers in their Medicaid and CHIP application and retention processes, such as taking advantage of new “express lane” provisions to minimize burdens on families.