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Chapter 6 - Children's Health Coverage

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CHAPTER 6 - CHILDREN'S HEALTH COVERAGE

Content Last Updated: 11/19/2012 4:31:17 PM
Graphics Last Updated: 3/21/2012 4:29:31 PM
Note: Terms in green will show glossary definitions when clicked.

Originally written by Bruce Lesley, First Focus, and updated by Bruce Lesley, Lisa Shapiro of First Focus, and Bill Erwin, Alliance for Health Reform. Updated by Beeta Rasouli November 15, 2012.

This chapter was made possible by the Robert Wood Johnson Foundation.

FAST FACTS

  • An estimated 7 million children under age 18 in this country were uninsured for all of 2011, according to the Census Bureau –9.4 percent of the nation’s children.1
  • Children between ages 12 to 17 have a higher uninsured rate when compared to children below the age of 12.2
  • Nearly 5 million children are eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) but are not enrolled.3
  • Uninsured rates for children vary dramatically by state, from a low of2.5percent in Massachusetts to a high of21 percent inNevada in 2011.4
  • Likewise, participation rates in Medicaid and CHIP vary by state – from a 2008 low of 55.4 percent of eligible children in Nevada to 95.4 percent in the District of Columbia.5
  • In 2008, almost four out of every 10 children eligible for Medicaid and CHIP but unenrolled lived in just three states – California, Texas and Florida.6
  • Although slightly down from 16.3 percent in 2010, Hispanic children are almost two and a half times as likely to be uninsured as non-Hispanic white children –15.1 percent vs.6.8 percent in 2011. Black children (10.2 percent) and Asian children (9.1 percent) were also more likely to be uninsured than whites, but significantly lessso than Hispanic children.7
  • 55 percent of children in the U.S. had health insurance coverage through their parent’s employer in 2011. About 36 percent had Medicaid coverage and approximately 6 percent had individual private coverage.8
  • The Patient Protection and Affordable Care Act of 2010 affects children’s coverage in a number of ways. Beginning in 2014, most children (like most adults) must have health coverage, either public or private.
  • Private insurers must now provide coverage for children with preexisting conditions. This means both providing coverage for preexisting conditions for currently insured children and not excluding children with preexisting conditions from future coverage.
  • Starting in 2014, the reform law provides refundable and advanceable tax credits to families with incomes between 133 and 400 percent of the federal poverty level to help them buy insurance through new exchanges.
  • The reform law maintains the Children’s Health Insurance Program (CHIP) through 2019. In 2015, states will receive a 23 percentage point increase in the federal CHIP match rate, up to 100 percent of costs. Current match rates range from 65 to 85 percent.
  • Dental caries, the disease causing cavities, is the most prevalent chronic condition among children. Yet, nearly three times as many children lack dental coverage compared to children without medical coverage.9

BACKGROUND

Despite all the pain it caused, the recent recession was associated with one positive outcome – more children now have health coverage than before the recession hit. Between 2007 and 2010, 1 million children gained coverage and the number of uninsured children shrank by more than 500,000.10

The recession stimulated congressional action that increased coverage among children. The economic stimulus bill signed in 2009 gave states financial incentives to sign up children for Medicaid and the Children’s Health Insurance Program (CHIP). In addition, the CHIP reauthorization bill of 2009 offered bonuses to states for successfully boosting Medicaid enrollment of children using proven tools. Dozens of states used such tools as simplifying enrollment and eliminating in-person interviews.11 12

The net result: 5.1 million children were added to the rolls of Medicaid and CHIP between 2007 and 2010, more than making up for the 3.4 million who lost coverage through private insurance (employer-based and direct purchase).13

But 7 million children remained uninsured in 2011.14 About 5 million of these were eligible for Medicaid and CHIP but weren’t enrolled.15

As states struggle to balance their budgets, however, some have deleted children from Medicaid or CHIP. For instance, in late 2010, Washington State was proposing to remove from the rolls 27,000 children who weren’t U.S. citizens or who did not have documentation to prove their citizenship.16

Even so, the number of children with coverage is expected to keep growing. The Patient Protection and Affordable Care Act of 2010 (ACA) removes barriers to coverage for children with pre-existing conditions. The law gives states the option of expanding Medicaid to cover more children. And as of 2014, almost everyone in the United States, including children, will have to have coverage, or else pay a penalty.17

Health policymakers have recognized and highlighted the unique health needs of children. For instance, CHIP was enacted to help children who don’t qualify for Medicaid but whose families can’t easily afford private coverage.

In Medicaid, broad pediatric coverage and benefits are provided through what is known as early and periodic screening, diagnosis, and treatment (EPSDT). This benefit, specific to children, was added to Medicaid in 1967 in response to high levels of preventable physical, dental, and mental health conditions among low-income children at that time, from preschool children enrolled in the Head Start program to young military draftees.18

HOW DO CHILDREN GET HEALTH COVERAGE?

The majority of children, an estimated55 percent, had coverage through their parents’ job-based insurance in 2011.19 But this share has declined in recent years. In 2000, by contrast, 66.7 percent had job-based coverage.

The recession and the resulting rise in unemployment contributed to this trend. A 2010 study found that, for every 1,000 jobs lost, 311 privately insured children lose coverage.20

Also, a shrinking number of eligible workers are taking up the coverage their employers offer, among both large and small employers.21 Employees are expected to pay more for premiums and for out-of-pocket expenses than in years past.22 23 Employer-sponsored coverage is now less affordable for families with incomes at 300 percent of the federal poverty level (FPL) than it was for families at 200 percent of FPL in 1999.24

While employer-sponsored coverage of children has dropped over time, Medicaid and CHIP coverage has increased, compensating for the employment-based decline. In 2010, an estimated26 million children had Medicaid or CHIP for the full year, compared to 15 million in 2000.25

Together Medicaid and CHIP cover one in three children (36 percent).26 (CHIP was previously called SCHIP—State Children’s Health Insurance Program—until passage of the program’s reauthorization in early 2009. Alliance Honorary Chairman Senator Jay Rockefeller in 1997 co-authored legislation that led to the development of CHIP.27 )

Children representednearly 50 percentof all Medicaid enrollees in 2011.28 But children constitute only a fraction of total program costs, since theyare relatively inexpensive to cover compared to other Medicaid enrollees.Federal law currently requires state Medicaid programs to cover children age 6 to 18 living in families with incomes below 100 percent of the federal poverty level or less, and children under age 6 living below 133 percent of the FPL.29 In contrast, CHIP eligibility in many states goes up to at least 200 percent of FPL30 . (See chart below, “2012 Federal Poverty Guidelines”).

2012 Federal Poverty Guidelines

Persons in family/household

48 Contiguous States and the District of Columbia

Alaska

Hawaii

1

$11,170

$13,970

$12,860

2

15,130

18,920

17,410

3

19,090

23,870

21,960

4

23,050

28,820

26,510

5

27,010

33,770

31,060

6

30,970

38,720

35,610

7

34,930

43,670

40,160

8

38,890

48,620

44,710

For each additional person, add

3,960

4,950

4,550

SOURCE:  Federal Register, Vol. 77, No. 17, January 26, 2012, pp. 4034-4035

 

In 1997, a Republican-led Congress passed and President Bill Clinton signed the legislation creating CHIP – the largest expansion of health insurance coverage for children in more than 30 years.31 CHIP was designed to expand and complement Medicaid by providing health coverage for uninsured children whose families earn too much to qualify for Medicaid, but who cannot afford private coverage.

More than 5 million children were enrolled in CHIP as of June 2011. Enrollment in CHIP continues to grow, however it has moderated since the beginning of the recession. Still, the percentage of uninsured children dropped from 10.9 percent in 2007 to 10 percent in 2010, mostly because of increased enrollment in Medicaid.32

Unlike Medicaid, which is an entitlement program, CHIP is funded as a capped block grant to states. Under CHIP, each state is given a certain amount of money per year, determined by a formula established by Congress at the program’s creation and modified several times since.

To give states incentives to cover an expanded population of low-income children, the federal government provides states with an “enhanced” matching rate in comparison to Medicaid. For every dollar states spend on CHIP, they get more federal money than they do for every dollar they spend for Medicaid.

For CHIP, the federal government paid from 65 percent to 82 percent of total program costs in FY 2011, depending on the state, in contrast to a 50- to 75- percent matching rate for Medicaid.33 The Medicaid matching rate (also known as Federal Medical Assistance Percentage) temporarily increased by 6.2 percentage points for each state under the economic stimulus legislation passed by Congress in early 2009.34 The temporary bonus payments then ended in June 2011.35

(For FY 2012, state-by-state matching rates for Medicaid and CHIP, not counting the changes contained in the stimulus bill, go to http://aspe.hhs.gov/health/fmap12.shtml.)

CHIP offers states wide latitude in designing and implementing their child health assistance programs, provided they meet certain minimum standards for benefits and design. Under CHIP, states can: (1) expand Medicaid beyond the June 1997 levels of coverage; (2) cover children through a program separate from Medicaid; or (3) combine the two approaches.36

Federal law requires that when children apply for CHIP coverage, their eligibility for Medicaid must be assessed first. Thus, many are found to be eligible for Medicaid, helping push up Medicaid enrollment.

Children often move from one program to the other as their family income fluctuates or even as they age out of Medicaid eligibility. Failed coordination between the two programs can sometimes result in a child “falling through the cracks” between Medicaid and CHIP.37

CHIP REAUTHORIZATION

Congress initially authorized CHIP for a 10-year period that expired at the end of September 2007. Congress and the Bush Administration deadlocked on the shape of CHIP for the future, and compromised by extending the program through March 2009. Ultimately, CHIP was reauthorized and enlarged early in 2009.38 The bill, signed by President Obama on February 4, 2009, increased CHIP funding by about $32 billion through 2013 to cover an additional 4 million children.39

CHILDREN AND THE ACA

On March 23, 2010, President Obama signed into law the ACA, which included key provisions related to children’s health coverage. Most notably, the legislation preserves and extends CHIP through September 30, 2019 with full funding for the program extended through fiscal year 2015. The legislation also includes a “maintenance of effort” provision, requiring states to maintain their current eligibility standards through 2019. States also are barred from imposing new paperwork or other barriers that would make it harder for people to enroll in Medicaid or CHIP.

Other provisions in the ACA to improve access, coverage, quality and outcomes for children include:40

  • Mandated coverage. Children (like adults) must have health coverage, either public or private, beginning in 2014, unless they fall into one of the exceptions provided by the law (e.g., religious objection, financial hardship). Elimination of pre-existing condition exclusions. Private insurers must offer coverage for children with pre-existing conditions. This means both providing coverage for pre-existing conditions for currently insured children and not excluding children with pre-existing conditions from future coverage. This requirement became effective with the insurance plan year beginning after Sept. 23, 2010 (Jan. 1, 2011 for most people).
  • Continued support for CHIP. The reform law maintains CHIP through 2019. In 2015, states will receive a 23 percentage point increase in the federal match rate, up to 100 percent of costs. Current match rates range from 65 to 85 percent.
  • Simplified enrollment measures. The ACA requires streamlined enrollment under Medicaid, CHIP and new state-level insurance exchanges.
  • Extended dependent coverage. The law allows dependent children to stay on their parents’ health plans until they reach age 26. This also became effective for most people on January 1, 2011.
  • More affordability for low-income families in the new exchanges. Starting in 2014, the law provides refundable and advanceable tax credits to families with incomes between 133 and 400 percent of the federal poverty level to help them buy insurance through new exchanges.
  • Elimination of lifetime limits. Insurers may no longer place lifetime limits on the dollar value of coverage. Beginning in 2014, insurers may no longer impose annual limits on coverage.
  • Extended Medicaid for foster youth. In 2014, the law extends Medicaid coverage to all foster youth below the age of 25 who were formerly in foster care for a period of six months.
  • Home visiting. The law provides funding to states to develop and implement evidence-based Maternal, Infant and Early Childhood Visitation models.
  • School-based health care. The law creates a federal authorization program and provides $200 million in short-term funding for school-based health centers.
  • Oral health. The law creates an oral health prevention campaign, dental carries disease management, school-based dental sealant programs and cooperative agreements to improve infrastructure and surveillance systems.
  • Bright Futures. The law requires that new health plans cover, at no cost, comprehensive screenings and preventative care for children as defined by the “Bright Futures” standards issued by the American Academy of Pediatrics.
  • Coverage of preventive health services. The law requires insurers to cover services, without out-of-pocket cost sharing, that have received an “A” or “B” rating from the United States Preventive Services Task Force (USPSTF), extending coverage for a broader range of preventive health services. (To see these recommended services, go to http://goo.gl/5YIkg.)
  • Child-only coverage option in the new exchanges. The ACA allows families to purchase child-only insurance packages in the exchanges, to allow access to coverage for children being cared for by grandparents, children with parents whose employers do not offer dependent coverage, and children in mixed immigrant-status households.
  • Childhood Obesity Demonstration Project. Authorized by Congress in the 2009 CHIP reauthorization, this project received $25 million through the ACA for a demonstration project to reduce childhood obesity.

WHICH CHILDREN ARE STILL UNINSURED?

Despite all the enrollment efforts and incentives mentioned earlier, 7 million children remained uninsured for all of 2011– 9.4 percent of all children.41 The uninsurance rate was highest for children who weren’t U.S. citizens – more than 30 percent without coverage. Hispanic children were much more likely to lack coverage than non-Hispanic children.

Children in households with an income of less than $25,000 were more likely to be uninsured than children in households with greater income. Children ages 12 to 17 had a higher uninsurance rate than younger children. The South had a higher incidence of uninsured children than other regions.42 (See chart, “Characteristics of Uninsured Children, 2009.”)

Participation rates of eligible children in Medicaid and CHIP vary tremendously by state. From June 2010 to June 2011, enrollment in 37 states grew. Six states; California, North Carolina, New York, Iowa, Oregon, and New Jersey, had more than 10,000 additional children enroll in this period. Enrollment in CHIP programs from June 2010 to June 2011 also declined in 14 states.43

LIKELY POLICY DEBATES

Children and National Health Reform

The Department of Health and Human Services has implemented provisions of the ACA that eliminate pre-existing condition exclusions for children and extend dependent coverage up to age 26.

Other key regulatory issues for children that are expected to be addressed in guidance in the coming weeks and months include: functionality issues related to exchange coverage, including how families will be treated with respect to eligibility for subsidies and transitions between public coverage and the exchanges; definitional issues related to pediatric benefits offered in the exchanges; and issues related to the elimination of cost-sharing for preventive care services.

Each of these issues is likely to draw competing opinions – from children’s advocates, providers and state budgeteers. Also, threatened congressional action to withhold funding for ACA implementation, if successful, could have implications for children’s coverage.

State Budget Woes and Health Care Funding

As noted, additional support for Medicaid was included in the economic stimulus bill enacted in early 2009. The American Recovery and Reinvestment Act temporarily increased each state’s Medicaid matching rate through December 31, 2010. Scaled back increases continued through June 2011, thanks to a separate law passed in mid-2010.44

Since temporary boost in funds ran out, states have been hard pressed to find funding to maintain eligibility levels and enrollment for children in Medicaid and CHIP – and are constrained by “maintenance of effort” sections of the ACA from reducing eligibility levels or enrollment practices. See the Medicaid chapter for more information.

The Children’s Hospital Association has released year-end State Legislative fact sheets for 2012. These fact sheets provide state-specific information on Medicaid/ CHIP financing, initiatives to improve health care quality, cost-sharing, reimbursement for Medicaid providers, and much more.45 Some facts include:

  • “Ten states enacted legislation to expand coverage for children or adults and/or decrease barriers to coverage/improve enrollment.”46
  • “Eight states enacted legislation related to health care quality.” 47
  • “Twelve states and the District of Columbia enacted bills affecting financing for Medicaid/CHIP.” 48


TIPS FOR REPORTERS

  • There is a unique children’s health angle in virtually every health care policy discussion, whether about emergency medicine, benefits, privacy, quality, comparative effectiveness, tax credits, or organ transplants. As issues arise during health care discussions, consider how children’s health issues are different from adult issues. Is there even a separate and distinct angle related to infant or adolescent health?
  • Parents of young children have insights into children's health needs that often amaze, and impress, child health professionals. Talk with parents at places where they gather, such as day care centers, library story sessions or play groups.
  • Some of the most powerful arguments for national health reform involve children with very expensive health conditions, and the devastating side effects this can have on their families and their finances. Get to know such families, and find out their views about changes still needed in the health care system.
  • Hispanic children are much more likely to be uninsured than children of other ethnicities. Why is this true? You will find many interrelated causes. What do Hispanic parents and advocates recommend as solutions?

STORY IDEAS

  • National health reform legislation is expected to improve health care access, coverage, and affordability, especially for low-income Americans and those who are currently uninsured. As the ACA is implemented, how does coverage that is offered through the new exchanges stack up against existing coverage options for low-income children? For example, CHIP provides comprehensive benefits for children and limits out of pocket costs to 5 percent of a family's income. Under health reform, will families have the option to retain this coverage? Will the exchanges offer families coverage that provides comparable benefits and cost-sharing?
  • Most states are facing budget shortfalls and growing needs for Medicaid and CHIP simultaneously in the aftermath of the economic recession. What is the impact on children’s coverage in your state?
  • In light of the federal government extending additional Medicaid dollars through June 2011 as part of state fiscal relief, what difference is this making directly to children’s coverage in Medicaid and indirectly in CHIP? What will the end of this funding mean for children’s coverage?
  • Two-thirds of the uninsured children in the country are eligible for, but not enrolled in, either Medicaid or CHIP. How do these programs coordinate health care delivery and enrollment in your state? What is your state doing with respect to outreach and enrollment of these children?
  • How does your state use health information technology to improve the enrollment of eligible, but unenrolled, children? Do they use mechanisms such as Express Lane Eligibility and SingleStop, which allow for sharing of data across programs to reduce bureaucracy and streamline enrollment? How can the eligibility system be improved to reduce the number of uninsured children in your state? According to your state, what are the federal barriers in place that preclude progress?
  • Federal spending on children’s welfare programs has declined by more than 11 percent over the past five years, in inflation-adjusted terms, constituting now just 10 percent of the federal non-defense budget in 2008.49 This includes funding reductions (when adjusted for inflation) for programs such as Head Start, the Maternal and Child Health Block Grant, and Healthy Start. How do these types of federal budget actions impact overall child health (e.g., infant mortality, childhood obesity and the Medicaid and CHIP programs)?
  • Dental caries (tooth decay) is the most prevalent, but also the most preventable chronic condition among children. What is your state or community doing to address this problem?
  • The health concerns of adolescents generally involve behavioral practices – from questions about sexuality and experimentation with drugs and alcohol to emotional problems, obesity or anorexia. If not handled well, these issues can become persistent health problems in adulthood. How is your community working to improve the lives and safety of adolescents? What are the health consequences for individuals in your community if behavioral issues have not been addressed?

ENDNOTES

1 U.S. Census Bureau (2012). “Income, Poverty, and Health Insurance Coverage in the United States: 2011.” http://www.census.gov/prod/2012pubs/p60-243.pdf

2 U.S. Census Bureau (2012) “Income, Poverty, and Health Insurance Coverage in the United States: 2010.” http://www.census.gov/prod/2012pubs/p60-243.pdf

3 Kathleen Sibelius (2010). “Rising to the Challenge: Tools for Enrolling Eligible Children in Health Coverage.” Health Affairs, October. www.healthaffairs.org

4 U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to2011” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

5 Genevieve M. Kenney, Victoria Lynch, Allison Cook and Samantha Phong (2010). “Who And Where Are The Children Yet To Enroll In Medicaid And The Children’s Health Insurance Program?” Health Affairs, September. http://content.healthaffairs.org/content/29/10/1920.abstract www.healthaffairs.org

6 Genevieve M. Kenney, Victoria Lynch, Allison Cook and Samantha Phong (2010). “Who And Where Are The Children Yet To Enroll In Medicaid And The Children’s Health Insurance Program?” Health Affairs, September. http://goo.gl/IwISv

7U.S. Census Bureau (2012) “Income, Poverty, and Health Insurance Coverage in the United States: 2011.” http://www.census.gov/prod/2011pubs/p60-243.pdf

8 U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to 2011.” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

9 Children’s Dental Health Project (2008). “Children's Oral Health National Facts.” http://goo.gl/uPBpY

10 U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to 2010.” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

11 Kathleen Sibelius (2010). “Rising to the Challenge: Tools for Enrolling Eligible Children in Health Coverage.” Health Affairs, October. www.healthaffairs.org

12 Martha Heberlein, Tricia Brooks and Jocelyn Guyer (2011). “Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011.” Kaiser Commission on Medicaid and the Uninsured, January. www.kff.org/medicaid/upload/8130.pdf

13 U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to 2010.” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

14 U.S. Census Bureau (2011 Income, Poverty, and Health Insurance Coverage in the United States: 2010.” http://www.census.gov/prod/2011pubs/p60-239.pdf

15 Kaiser Commission on Medicaid and the Uninsured (2011). “Health Coverage of Children: The Role of Medicaid and CHIP.” February. http://goo.gl/KK3mH

16 Jordan Schrader and Brad Shannon (2010). “Who in Washington state will get feds’ health funds?” News Tribune, Tacoma, WA, December 29. http://goo.gl/d8iLQ

17 Kaiser Family Foundation (2010). “Summary of New Health Reform Law.” http://goo.gl/ea6ZO

18 Rosenbaum, Sara and Wise, Paul (2007). “Crossing the Medicaid-Private Insurance Divide: The Case of EPSDT,” Health Affairs, March/April, pp. 383. www.healthaffairs.org

19 Kaiser Family Foundation (2010). “Health insurance coverage of children 0-18, States (2009-2010)” http://www.statehealthfacts.org/comparetable.jsp?ind=127&cat=3

20 Gerry L. Fairbrother and others (2010). “The Impact Of Parental Job Loss On Children’s Health Insurance Coverage.” Health Affairs, July, p. 1343. www.healthaffairs.org

21 Kaiser Family Foundation and Health Research and Educational Trust (2010). “Employer Health Benefits Annual Survey 2010.” Exhibit 3.6. http://ehbs.kff.org/

22 Kaiser Family Foundation and Health Research and Educational Trust (2010). “2010 Employer Health Benefits Survey.” Exhibit 6.2, Sept. 2. http://ehbs.kff.org

23 Kaiser Family Foundation and Health Research and Educational Trust (2010). “2010 Employer Health Benefits Survey.” Exhibit 7.12, Sept. 2. http://ehbs.kff.org/

24 Calculated from figures in Kaiser Family Foundation and Health Research and Educational Trust (2010). “2010 Employer Health Benefits Survey.” Exhibit 6.2, Sept. 2. http://ehbs.kff.org/ and “2010 Poverty Guidelines” http://goo.gl/XvJo5 and “1999 HHS Poverty Guidelines” http://goo.gl/S2Y9b

25U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to 2010.” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

26 U.S. Census Bureau (2012). “Table HIB-5. Health Insurance Coverage Status and Type of Coverage by State--Children Under 18: 1999 to 2011.” http://www.census.gov/hhes/www/hlthins/data/historical/HIB_tables.html

27 For more information on Sen. Rockefeller’s involvement with CHIP, please see his website’s press releases, which can be found at: http://goo.gl/wfcI6), http://goo.gl/l1660 and http://goo.gl/J1gdd

28 Congressional Budget Office. “Medicaid Spending and Enrollment Detail for CBO’s March 2012 Baseline.” http://www.cbo.gov/sites/default/files/cbofiles/attachments/43059_Medicaid.pdf

29 Kaiser State Health Facts (2012). “
Income Eligibility Limits for Children's Regular Medicaid and Children's CHIP-funded Medicaid Expansions as a Percent of Federal Poverty Level (FPL), January 2012.” http://www.statehealthfacts.org/comparereport.jsp?rep=76&cat=4

30 Kaiser State Health Facts(2012). “Income Eligibility Limits for Children's Regular Medicaid and Children's CHIP-funded Medicaid Expansions as a Percent of Federal Poverty Level (FPL), January 2012” January 2012; http://www.statehealthfacts.org/comparereport.jsp?rep=76&cat=4

31 Genevieve Kenney and Justin Yee (2007). “SCHIP at a Crossroads: Experiences to Date and Challenges Ahead,” Health Affairs. March/April , pp. 356-369. www.healthaffairs.org

32 Kaiser Commission on Medicaid and the Uninsured. CHIP Enrollment: June 2011 Data Snapshot. June 2012. http://www.kff.org/medicaid/upload/7642-07.pdf

33 U.S. Dept. of Health and Human Services. “Federal Financial Participation in State Assistance Expenditures, FY 2011.” http://goo.gl/rsq3Q

34 The American Recovery and Reinvestment Act of 2009 (H.R.1.) Section 5001, Temporary Increase of Medicaid FMAP. http://goo.gl/yriEk

35 Janice Simmons (2010). “$26 Billion FMAP Extension Bill Signed into Law.” HealthLeaders Media, August 11. http://goo.gl/du3ms

36 Centers for Medicare and Medicaid Services. “State Children’s Health Insurance Summary.” http://goo.gl/afPWX

37 Bergman, David (2005). “Perspectives on Reauthorization: SCHIP Directors Weigh In.” National Academy for State Health Policy, June 2005. http://goo.gl/49IId

38 U.S. House Energy and Commerce Committee (2008). “Bill Summary: Children’s Health Insurance Program Reauthorization Act of 2009.” http://goo.gl/LNfIP

39 Kevin Freking and Philip Elliott (2009). “Obama Signs Bill Insuring More Children.” Associated Press, February 5. http://goo.gl/bmL1y

40 Kaiser Family Foundation (2010). “Summary of the New Health Reform Law.” (www.kff.org/healthreform/8061.cfm)

41 U.S. Census Bureau (2011) “Income, Poverty, and Health Insurance Coverage in the United States: 2010.” http://www.census.gov/prod/2011pubs/p60-239.pdf

42 U.S. Census Bureau (2010). “Income, Poverty, and Health Insurance Coverage in the United States:2009.” Pp. 27-28. http://goo.gl/Qo2AC

43 Kaiser Commission on Medicaid and the Uninsured. CHIP Enrollment: June 2011 Data Snapshot. June 2012. http://www.kff.org/medicaid/upload/7642-07.pdf

44 Janice Simmons (2010). “$26 Billion FMAP Extension Bill Signed into Law.” HealthLeaders Media, August 11. http://goo.gl/YSftn

45 Children’s Hospital Association (2012). “2011 State Legislative Action on Children’s Health Care: Year-end Fact Sheets.” https://www.childrenshospitals.net/AM/Template.cfm?Section=N_A_C_H_News_and_Resources&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=60478

46 Children’s Hospital Association (2012). “Health Care Coverage.” http://www.childrenshospitals.net/AM/Template.cfm?Section=N_A_C_H_News_and_Resources&Template=/CM/ContentDisplay.cfm&ContentID=60436

47 Children’s Hospital Association (2012). “Initiatives to Improve Health Care Quality.” http://www.childrenshospitals.net/AM/Template.cfm?Section=N_A_C_H_News_and_Resources&Template=/CM/ContentDisplay.cfm&ContentID=60437

48 Children’s Hospital Association (2012). “Medicaid/CHIP Financing.” http://www.childrenshospitals.net/AM/Template.cfm?Section=N_A_C_H_News_and_Resources&Template=/CM/ContentDisplay.cfm&ContentID=57919

49 First Focus (2008). “Children’s Budget 2008.” April 23. http://goo.gl/dbEtc

 
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09.24.2012 - Angel Network provides practical wings, helps families , Glenn Evans (gevans@etcnonline.com), TheGladewaterMirror.com

Medicaiddoesn't pay for gas or for other non-medical, but related, expenses. But the Angel Network helps.

09.17.2012 - Boot camp a weight-loss option for area kids, Cameron Steele csteele@annistonstar.com, The Anniston Star

Concerned about overweight kids, the Anniston pediatric nurse practitioner is launching a boot camp for kids that will teach routines that involve jumping and interval training.

06.29.2012 - Supreme Court's 5-4 decision benefits kids, but Medicaid stalls, Victor R. Martinez (VMartinez@elpasotimes.com), El Paso Times

The Supreme Court's decision is good for children, but it doesn't expand the overall pool of Medicaid dollars, says CEO of El Paso Children's Hospital.

 

Graphics for This Chapter

How Children Get Health Coverage

Uninsured Children by Poverty Status

Federal Poverty Guidelines 2011

How Children Get Health Coverage, 2000 vs. 2010

2012 Federal Poverty Guidelines

 

This sourcebook for journalists was made possible with the support of the Robert Wood Johnson Foundation.

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