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More children in lower-income families are covered by public health insurance

Bolstered by the federal health care law, the number of lower-income children getting health coverage continues to rise, a study found.

In 2014, the first full year of the law's implementation, 91 percent of children who were eligible for Medicaid or the Children's Health Insurance Program were enrolled, according to the study by researchers at the Urban Institute. In 2013, that figure was 88.7 percent, and only 81.7 percent in 2008. Medicaid and CHIP are federal-state health coverage programs for lower-income residents, but CHIP provides coverage for children whose families earn too much to qualify for Medicaid.

Given that coverage rates were already quite high for children, "I was surprised to see gains to such an extent in 2014, and for that to happen for so many different kinds of children and in so many different places," said Genevieve Kenney, co-director of the Urban Institute's Health Policy Center who was an author of the study.

The biggest coverage increases occurred in states that expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level (about $33,500 for a family of four), probably a spillover effect as adults signed up and learned that their children were eligible, too. So far 31 states and the District of Columbia have adopted the Medicaid expansion.

The coverage increase among children eligible for Medicaid and CHIP mirrors changes in the non-insured rate for children overall, which fell from 7 percent in 2013 to 5.8 percent in 2014, the researchers noted. They estimated that 4.5 million children younger than 18 are still uninsured. That population varies significantly among states, according to the report, with the rate of uninsured children below 4 percent in 14 states and above 9 percent in four: Alaska, Arizona, Nevada and Texas.

There were coverage gains for all types of children from 2013 to 2014, including those of different ethnic groups, ages and family incomes. But progress has been slower for some groups, including adolescents ages 13 to 18, and Hispanic children in families in which no parent speaks English.

The study used data from the American Community Survey, an ongoing survey by the U.S. Census Bureau that includes data on more than 700,000 children age 18 and younger.

Nearly two-thirds of the 4.5 million children who were uninsured in 2014 were eligible for Medicaid or CHIP, the study found. Many of them have been enrolled in Medicaid at some point in their lives, Kenney said.

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"That puts the spotlight on renewal and retention," Kenney said. States have adopted different strategies to encourage continued coverage. Some have policies that allow children to stay enrolled in Medicaid or CHIP for the full year even if their parents' income or other circumstances change. Others determine whether children are still eligible for the programs by conducting data checks rather than requiring parents to fill out paperwork.

Kenney said she expects the non-insured rates for children improved again in 2015 as more states expanded Medicaid and families enrolled in subsidized insurance on the state marketplaces. This month, Arizona reinstated its CHIP program, after freezing enrollment in 2009, thus extending coverage to more lower-income children.

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(Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.)

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