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Public Health Insurance for Children


» View national participant and spending data

Public health insurance for children provides low-income—and, in some states, moderate-income—children with free or low-cost health insurance coverage. The two major federal funding sources for this benefit are Medicaid and the State Children’s Health Insurance Program (SCHIP).

Medicaid is by far the larger of the two programs, serving more than 20 million children. SCHIP covers over 3 million children. Both Medicaid and SCHIP require state matching funds, although the federal government pays a larger share of the cost of care provided through SCHIP. States may use SCHIP dollars to increase children’s coverage by expanding their Medicaid programs and/or creating separate SCHIP programs. About a third of the states have implemented Medicaid expansions, another third have created separate SCHIP programs, and the rest have chosen a combination of these approaches. In addition, SCHIP and Medicaid funds may be used to subsidize the enrollment costs (or premiums) of employer-based coverage for children.

Federal requirements establish minimum income eligibility limits, minimum benefit packages, and strict limits on cost-sharing for state Medicaid programs for children. States, however, determine application procedures, which affects access to coverage. States also determine how family income is calculated, resulting in significant differences in eligibility.

Medicaid SCHIP expansion programs must meet the federal Medicaid standards, but greater flexibility is allowed in separate SCHIP programs. Benefit packages and cost-sharing provisions in these programs vary considerably. There is also significant variation in income eligibility limits for children, although as of 2009, 45 states (including the District of Columbia) had expanded coverage to reach children up to or above 200 percent of the federal poverty level ($36,620 per year for a family of three in 2009). Fifteen states (including the District of Columbia) offered coverage to parents at this earnings level, notwithstanding research showing that children are more likely to be enrolled in health insurance programs and access services when their parents are also eligible for coverage.

In addition, while Medicaid is an entitlement program that guarantees coverage to all eligible applicants (and this guarantee extends to SCHIP-funded Medicaid expansions), there is no entitlement to coverage under separate SCHIP programs.

Medicaid was enacted in 1965 to provide health insurance coverage for certain needy populations, including families receiving cash assistance, low-income children, the elderly, and the disabled. In the late 1980s and early to mid-1990s, Medicaid was gradually “de-linked” from cash assistance, beginning with coverage for pregnant women and young children. In 1996, Medicaid was fully separated from cash assistance, but with the requirement that states create a “Family Coverage Category” that offers coverage to families who meet the state’s 1996 cash assistance eligibility criteria. The following year, the SCHIP block grant was created to expand health insurance coverage for children.

National Participant & Spending Data

Participants

Number of recipients

Number of children in Medicaid (including Medicaid SCHIP)129.9 million children (FY 2008)2
Number of children in Medicaid SCHIP32.1 million children (FY 2008)
Number of children in separate SCHIP35.3 million children (FY 2008)

Benefit coverage

Percent of children without health insurance coverage411% (2007)
Percent of low-income children without health insurance coverage518% (2007)

Spending

Total spending

Total spending on children in Medicaid (state and federal)6$44.2 billion (FY 2004)2
Total spending in Medicaid SCHIP (state and federal)7$1.6 billion (FY 2004)
Total spending in separate SCHIP (state and federal)8$5.0 billion (FY 2004)

Data Notes and Sources

Last Updated: November 30, -0001

  1. Figure reflects "Medicaid Eligibles" (i.e., persons enrolled in Medicaid during the year, whether or not they received health care services).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual Statistical Enrollment Report FY2008, http://www.cms.hhs.gov (accessed April 9, 2009).
  2. Figure reflects total for 50 states and the District of Columbia.
  3. Figure reflects number of persons enrolled during the year. Data are based on state enrollment data submitted in the Statistical Enrollment Data System (SEDS).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Annual Statistical Enrollment Report FY2008, http://www.cms.hhs.gov (accessed April 9, 2009).
  4. Figure reflects the percent of children under age 18 who did not have health insurance coverage at any point during the year.
    Current Population Survey, 2008 Annual Social and Economic Supplement, "Health Insurance Coverage Status and Type of Coverage by State and Age for All People" http://pubdb3.census.gov (accessed September 3, 2008).
  5. Figure reflects the percent of children under age 19 at or below 200% of the poverty level who were not covered by a health plan at any time in the year.
    Current Population Survey, 2008 Annual Social and Economic Supplement, "Number and Percent of Children Under 19 at or below 200% of Poverty by Health Insurance Coverage and State: 2007 (SCHIP allocation formula)" http://pubdb3.census.gov (accessed September 30, 2008).
  6. Figure reflects Medicaid payments for persons whose "Basis of Eligibility" is "Child" or "Foster Care Child"; payments for children who are blind/disabled are not included. Data are based on states' eligibility and claims data submitted through the Medicaid Statistical Information System (MSIS), and they include spending on children enrolled in SCHIP-funded Medicaid expansions, where applicable (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicaid Statistical Information System (MSIS) State Summary FY2004, http://www.cms.hhs.gov (accessed August 9, 2007).
  7. Data are based on the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (Form CMS-64) submitted by states (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
    Centers for Medicare and Medicaid Services, "Net Reported Medicaid and SCHIP Expenditures," http://www.cms.hhs.gov (accessed August 10, 2007).
  8. Figure may also include administration costs associated with expanding children's coverage in an SCHIP-funded Medicaid expansion. Data are based on the Quarterly State Children's Health Insurance Program Statement of Expenditures for Title XXI (Form CMS-21) submitted by states (for more information about these data, see http://www.cms.hhs.gov).
    Centers for Medicare and Medicaid Services, "Net Reported Medicaid and SCHIP Expenditures," http://www.cms.hhs.gov (accessed August 10, 2007).