The Impact of Medicaid and SCHIP on Low-Income Children’s Health

Full Report

This brief was prepared by Caryn Marks, Cathy Hoffman and Julia Paradise of the Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation.

THE IMPACT OF MEDICAID AND SCHIP ON LOW-INCOME CHILDREN’S HEALTH

Today, one-quarter of children in the U.S. and half of all low-income children receive their health coverage through Medicaid or the State Children’s Health Insurance Program (SCHIP), the nation’s major public coverage programs for low-income people. Medicaid covers 29 million poor and near-poor children and SCHIP covers 7 million additional low-income children. Still, nearly 9 million children remain uninsured; most of these children are eligible for Medicaid or SCHIP but are not enrolled. Against the backdrop of the current debate surrounding the reauthorization of SCHIP, the budgetary pressures on public coverage programs from the economic downturn, and the interest in reducing the number of uninsured children, this policy brief reviews the literature and examines the impact of Medicaid and SCHIP on coverage, access to care, and health for the nation’s low-income children.

The key points in the policy brief are:

Medicaid and SCHIP have expanded health coverage among low-income uninsured children.  Between 1998 and 2007, the uninsured rate among low-income children fell by almost half, from 28 percent to 15 percent, due in part to coverage through these programs. This improvement in coverage of children occurred at the same time that coverage of adults in the U.S. was deteriorating.

Public coverage has increased access to care. Children covered by Medicaid or SCHIP are much more likely to have a usual source of care, and to have had a doctor visit and much less likely to have unmet needs, compared with uninsured children. Access to preventive and primary care is roughly equivalent between publicly and privately covered children, including children with special health care needs. Parents with a publicly insured child rarely report forgoing care for the child due to cost – no more often than parents with a privately insured child. Maintaining continuous coverage is important because even brief gaps in children’s coverage are associated with reduced access to care and increased rates of unmet need and forgone care due to cost. Public coverage has also helped to narrow racial/ethnic disparities in access to care among children.

But access challenges remain. While publicly as well as privately insured children have high rates of access to primary and preventive care, system-wide shortages of pediatric specialists and dentists result in more limited access to these services. Low provider participation and payment rates in Medicaid compound these problems.

Public coverage has improved quality of care and health outcomes. Enrollment in public coverage is associated with improvements in the quality of care that previously uninsured children receive. For example, after being enrolled in New York’s SCHIP, children with asthma had fewer emergency department visits and hospitalizations. Additionally, improvements in physical and social health outcomes, including school attendance, for both healthy and chronically ill children, have been linked to public coverage programs. As federal and state actions to expand children’s coverage move forward on many fronts, Medicaid and SCHIP offer the potential to reduce the number of uninsured children and improve the care and health of millions of low-income children.

Read the full policy brief here.