Even as states struggled to meet their Medicaid obligations during the recession, most increased the percentage of kids covered under the Children's Health Insurance Program (CHIP). Thirty states boosted the proportion of eligible kids covered under the federal-state program and the national average moved from 80 percent to nearly 85 percent, according to a new report by the Robert Wood Johnson Foundation and the Urban Institute. Preliminary U.S. Census data suggests that expansion is continuing, the study says.
That's good news for state policy makers charged with expanding overall Medicaid enrollment by 39 percent under the Affordable Care Act. According to the study's authors, the same techniques states used to sign up a rising number of uninsured kids during the recession could be applied to adults in 2014 when Medicaid income eligibility is ordered to expand from 100 percent of the federal poverty level to those earning 133 percent or less.
But a few big states have lagged behind. California, Florida and Texas, which account for 40 percent of all eligible uninsured children in the country, have participation rates that fall below the national average. According to the study, enrollment would likely go up in those states if policy makers took a number of proven steps. For example, California and Texas could stop requiring paper documentation of income and instead use electronic data as most other states do.
Since CHIP was launched in 1997 — providing a bigger federal funding share for children than for adults under Medicaid — most states have stepped up outreach programs and made it easier for parents to apply and renew coverage.
As family incomes fell during the recession, the number of children eligible for Medicaid and CHIP increased by an estimated 2.5 million, rising from 40.2 million in 2008 to 42.7 in 2009. Even so, 30 states were able to increase the percentage of those enrolled in the program.
In 16 states — Arkansas, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Kentucky, Maine, Massachusetts, Michigan, Nebraska, New York, Rhode Island, Tennessee, Vermont and West Virginia — at least 90 percent of all eligible kids were signed up for the program by 2009.
In 2008, when the recession began, CHIP enrollment was about 80 percent nationally, with wide variations among states. Since then, states with the lowest historical enrollment rates have generally made the most progress, evening out much of the differences, according to the report.
Regionally, the Northeast has the highest enrollment rates at 89.6 percent in 2009. The South and the West have the lowest rates at 83.1 percent and 82.9 percent, respectively.