• Fact Sheet
  • January 30, 2011

Health Care Coverage Sources for America’s Children

Coverage programs form a critical system protecting our nation’s children.

Children receive health care coverage through an array of programs that includes Medicaid, the Children’s Health Insurance Program (CHIP), TRICARE, individual commercial health insurance sold through the Exchanges and employer-sponsored insurance (ESI). Together, these programs create a system of coverage that protects our nation’s kids, and investment in that system remains critical. As conversations around health care reform continue, it is important that any changes to these programs are carefully considered and kids’ coverage does not lose ground.

Health care coverage programs overview

Medicaid


  • There are approximately 30 million children who receive affordable coverage via the jointly funded federal-state Medicaid program.1

  • Medicaid is a vital lifeline to children in low-income families and to children with special health care needs.

  • Children represent over 40 percent of all Medicaid enrollees, but they account for less than 20 percent of Medicaid spending.2

  • Medicaid provides children access to medically necessary and age-appropriate services through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.


Children's Health Insurance Program 


  • About 6 million children receive coverage via the CHIP program.

  • CHIP is a jointly funded federal-state health coverage program that provides health insurance for low-income children and pregnant women with incomes too high to qualify for Medicaid.3

  • CHIP is designed with children’s needs in mind, including pediatric-specific benefits and cost-sharing protections.

  • Each state has the flexibility to design their own CHIP program.

 Employer-sponsored insurance

  • Around 37 million children ages 18 and under are insured through a parent or guardian’s employer-sponsored coverage.4

  • Not all employers offer coverage for dependents, including children.

  • In general, employers can choose the benefits they will cover, but many states mandate that certain benefits are covered. A growing number of employers are choosing to self-fund their coverage rather than purchase it through an insurance company, exempting them from state-mandated benefits.

 Exchanges


  • In 2016, more than 1 million children under age 18 were in a commercial plan sold through a health insurance Exchange.5

  • Exchanges were authorized under the Affordable Care Act. Many who purchase commercial coverage through the Exchanges are eligible for financial assistance via premium subsidies and reductions in their cost-sharing obligations.

  • Plans must meet certain requirements to be sold through the Exchanges, including coverage of specific types of benefits – such as pediatric services, mental health, and habilitative services and devices – and assurances that their provider networks include sufficient numbers and types of providers.

TRICARE


  • Approximately 1.5 million children are enrolled in TRICARE.6

  • TRICARE is run by the Department of Defense for active duty service members and their families.

  • TRICARE follows a Medicare model which does not provide a children’s benefit comparable to EPSDT.

  • Children in military families undergo unique experiences due to the nature of their parent’s service. Military families often switch providers due to moves and rely on mental health providers.

Uninsured


  • 5 percent of children are uninsured.7 This is the lowest uninsured rate in history. More than 70 percent of uninsured kids qualify for public coverage, but are not enrolled.8

  • Children without health insurance lack a regular source of care or medical home, and are more likely to be sicker when they do access care.

Coverage and children's hospitals


  • Children’s hospitals serve children covered by all of these programs.

  • Approximately half of all patients treated at children’s hospitals are covered by Medicaid and CHIP.9

  • All children benefit from the pediatric training, clinical care, research and child health advocacy provided together only in America’s children’s hospitals.


Sources

  1. Centers for Medicare and Medicaid Services, Medicaid and CHIP: November 2016 Application, Eligibility And Enrollment Report. Web Accessed Jan. 4, 2017.
  2. Congressional Budget Office March 2016, Medicaid Budget Projections. Web Accessed January 2017.
  3. Centers for Medicare and Medicaid Services, Medicaid and CHIP: November 2016 Application, Eligibility And Enrollment Report. Web Accessed Jan. 4, 2017.
  4. The Henry J. Kaiser Family Foundation “Employer-Sponsored Coverage Rates for the Nonelderly by Age." Web Accessed December 2016.
  5. ASPE, HHS, Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report. Web Accessed Jan. 4, 2017.
  6. DoD Evaluation of the TRICARE Program: Fiscal Year 2016 Report to Congress.
  7. Kaiser Family Foundation, Health Insurance Coverage of Children 0-18. Estimates based on the Census Bureau’s March 2014, March 2015, and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements). Web. Accessed Jan. 4, 2017.
  8. Alker, J. and Chester, A., Georgetown University Center for Children and Families, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” October 2016. Web Accessed January 2017.
  9. Children’s Hospital Association analysis using PHIS database of children’s hospitals, 2015-2016.

   

SOURCES

  1. Centers for Medicare and Medicaid Services, Medicaid and CHIP: November 2016 Application, Eligibility And Enrollment Report. Web Accessed 1/4/2017: https://www.medicaid.gov/medicaid/ program-information/downloads/november-2016-enrollment-data.zip
  2. Congressional Budget Office March 2016, Medicaid Budget Projections. Web Accessed 1/2017: https://www.cbo.gov/sites/default/files/recurringdata/51301-2016-03-medicaid.pdf
  3. Centers for Medicare and Medicaid Services, Medicaid and CHIP: November 2016 Application, Eligibility And Enrollment Report. Web Accessed 1/4/2017: https://www.medicaid.gov/medicaid/ program-information/downloads/november-2016-enrollment-data.zip
  4. The Henry J. Kaiser Family Foundation “Employer-Sponsored Coverage Rates for the Nonelderly by Age." Web Accessed 12/2016: http://kff.org/other/state-indicator/rate-by-age-2/?currentTimeframe=0
  5. ASPE, HHS, Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report. Web Accessed 1/4/2017: https://aspe.hhs.gov/sites/default/files/pdf/187866/ Finalenrollment2016.pdf
  6. DoD Evaluation of the TRICARE Program: Fiscal Year 2016 Report to Congress.
  7. Kaiser Family Foundation, Health Insurance Coverage of Children 0-18. Estimates based on the Census Bureau’s March 2014, March 2015, and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements). Web. Accessed 1/4/2017: http://kff.org/other/state- indicator/children-0-18/?currentTimeframe=0
  8. Alker, J. and Chester, A., Georgetown University Center for Children and Families, “Children’s Health Coverage Rate Now at Historic High of 95 Percent,” Oct. 2016. Web Accessed 1/2017: http://ccf.georgetown.edu/wp-content/uploads/2016/11/Kids ACS-update-11-02-1.pdf
  9. Children’s Hospital Association analysis using PHIS database of children’s hospitals, 2015-2016.