Press Release

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September 02, 2010

Craig Palosky
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Sue Ducat
Director of Communications
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From Health Affairs


American Children Without Health Insurance: Who They Are, Where They Live, And Tools To Get Them Enrolled


Washington, D.C. - At the beginning of this year, the U.S. Department of Health and Human Services (HHS) launched an initiative called Connecting Kids to Coverage, designed to identify (and subsequently enroll) the nearly five million uninsured children thought to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In the past it had been difficult to produce accurate estimates on the number of uninsured children in each state. However, the paper released today by Health Affairs succeeded by creating a new model, using data from the American Community Survey, an annual sample of some 700,000 children nationwide collected by the U.S. Census Bureau. This technique enabled the authors to produce meaningful national and state estimates of Medicaid/CHIP participation rates, which ranged from 55 percent to 95 percent enrollment, with ten states having participation rates close to or above 90 percent.

Who And Where Are The Children Yet To Enroll In Medicaid And The Children’s Health Insurance Program?
By Genevieve M. Kenney, Victoria Lynch, Allison Cook, and Samantha Phong
Kenney and Lynch are affiliated with Health Policy Center, Urban Institute, in Washington, D.C., Kenney as a senior fellow and Lynch as a research associate; Cook is a graduate student at Tufts University in Boston; and Phong is a research assistant at the Hoover Institution at Stanford University in Stanford, CA. The research and the Urban Institute Health Policy Center’s American Community Survey (ACS) Medicaid/CHIP Eligibility Simulation Model were developed under a grant from the Robert Wood Johnson Foundation.


The estimates are derived from the 2008 American Community Survey, and focus on children eighteen and younger in the civilian noninstitutionalized population. The authors found some 7.3 million uninsured children on an average day in 2008, of whom 4.7 million (64 percent) were eligible for Medicaid or CHIP but not enrolled. Some 61 percent of the uninsured children lived in ten populous states, with California, Texas, and Florida accounting for 38.6 percent of those children. Additionally, the authors report variations across ethnic subgroups, and found that children ages 0-5 had a 10 percent higher participation rate than those ages 13-18. The authors note that their analysis pertains to 2008, the year before the program’s reenactment and also before the economic recession set in. “These estimates indicate that outreach efforts and policy reforms aimed at improving eligibility, enrollment, and retention processes will need to reach children of different ages, incomes, races, ethnic groups, and primary language, given the diversity of the remaining eligible uninsured population,” they conclude. Future research, they say, would be helpful in assessing the extent to which state population characteristics as well as specific state policies regarding Medicaid/CHIP eligibility for children and their families explain variations in participation rates across states.

The second article released today is a commentary by HHS Secretary Kathleen Sebelius, outlining measures that HHS, other federal agencies, and states are implementing to enroll five million uninsured children in Medicaid/CHIP. She also cites existing state and community efforts to enroll more children and the steps that state and local governments as well as the private sector can take to expand outreach efforts, increase enrollment, and keep eligible children covered.


Rising To The Challenge: Tools For Enrolling Eligible Children In Health Coverage
By Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services


While Secretary Sebelius points out that the Affordable Care Act is expected to enroll thirty-two million additional Americans by 2019, she states that children eligible for Medicaid and CHIP can be enrolled immediately. Connecting Kids to Coverage will provide incentives to groups ranging from other federal agencies to community-based health centers and Indian tribes, in order to find and enroll these five million children eligible for Medicaid or CHIP coverage under existing program rules.

About Health Affairs

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.