New Report Finds that Expanding Medicaid and CHIP to Parents May Improve Coverage Rates of Children

States that have expanded their Medicaid and CHIP programs to parents have "far lower" rates of uninsured eligible children than states that do not cover parents, according to a new study from the Commonwealth Fund (Commonwealth Fund release, 5/30). Jeanne Lambrew of George Washington University conducted a 50-state analysis of the number of uninsured children and parents and the various income eligibility limits for both groups in each states. Below are some of the report's main findings:

• More than nine million parents are uninsured nationwide, with roughly two-thirds of them having income below 200% of the federal poverty level ($36,000 for a family of four). Uninsured parents and children comprise 50% of the low-income uninsured population.
• For 1999, the uninsured rate among low-income parents is 33%, compared to 23% of low-income children -- the greater percentage of covered children "results, in part, from success in Medicaid and CHIP expansions." Moreover, the rate of uninsured, low-income parents has increased from 31% to 33% from 1996-1999, while the number of uninsured children declined one million from 1998 to 1999.
• "States that extended eligibility to parents above poverty have nearly half the uninsured child rate as those with low eligibility limits."
• Nearly three-fourths of "uninsured children eligible for Medicaid or CHIP have at least one parent who is uninsured," suggesting that "one way to find and insure more children is to extend health coverage to their parents."
• "Low-income children with insured parents are nearly twice as likely to have health insurance as children with uninsured parents."

One Step at a Time?
Referencing Lambrew's findings, a June 1 Washington Post article examines problems states have had in enrolling children in CHIP and the possible implications of these difficulties on extending coverage to parents. The Post reports that by the end of last year, fewer than two million of the nation's 10 million uninsured children were enrolled in CHIP, with reasons for the lack of coverage including: lack of knowledge among low-income parents that the program exists; fear among immigrants about deportation; and enrollment barriers, such as face-to-face interviews and asset tests. According to a Robert Wood Johnson Foundation study, 60% of parents whose children qualify for Medicaid or CHIP do not think they are eligible. The Post reports that Sen. Edward Kennedy (D-Mass.), who is slated to chair the Senate Health, Education, Labor and Pensions Committee after the Senate reorganization, plans to introduce legislation that gives states $70 billion to extend Medicaid or CHIP coverage to parents. But according to Judy Whang, senior program officer at the Robert Wood Johnson Foundation, while advocates are "eager ... to develop innovative ways to go beyond CHIP," they "realize they need to adopt a 'max-out strategy'" before extending the program. Ron Pollack, executive director of Families USA, added, "If [CHIP] doesn't work, or is perceived not to be working, it disparages our efforts to go beyond" children (Connolly, Washington Post, 6/1).