A new report in the Urban Institute’s Quick Strike series finds that despite the U.S. economic downturn, most states have maintained or even improved children’s access to much-needed health care over the last several years by expanding eligibility and improving enrollment and retention in Medicaid and the Children’s Health Insurance Program (CHIP). The report presents the most up-to-date estimates available on Medicaid/CHIP participation rates, and examines how participation, eligibility, and rates of being insured have changed among children between 2008 and 2010 and examines participation rates among parents.

Nationally, the number of uninsured children in the United States who are not enrolled in public health insurance programs for which they are eligible fell 10 percent – from 4.9 million in 2008 to 4.4 million in 2010, according to a new analysis of government data. The most recent figures show that, nationwide, 86 percent of eligible children without private coverage were enrolled in public programs in 2010. That means that more than eight in 10 children who are eligible for Medicaid or CHIP but who do not have private coverage were enrolled in the programs. The programs are designed to ensure that children who would likely otherwise be uninsured have access to the health care they need.

The authors say the success of these programs in enrolling eligible children holds clues for enrolling eligible adults – an integral part of health reform, which is expected to greatly expand Medicaid to cover more uninsured adults in states that adopt the Medicaid expansion provision under the Affordable Care Act (ACA).

Key takeaways include:

• In 2010, 14 states (Ariz., Conn., Del., D.C., Hawaii, Ill., La., Maine, Mass., Mich., N.Y., Tenn., Vt., and W.Va.) had Medicaid/CHIP participation rates of 90.0 percent or higher. In contrast, six states (Colo., Idaho, Mont., Nev., Texas, and Utah) had participation rates below 80 percent. Several states saw increases close to or more than 10 percentage points. No state had a statistically significant decline in their Medicaid/CHIP participation rate for children between 2008 and 2010.
• In the 2009-2010 period, national participation rates were lower for eligible parents (65.6%) than for children (85.1%), a situation also true in every state. States that had relatively higher/lower participation rates among children were more likely to also have higher/lower rates among parents.