A Georgetown University Center for Children and Families report released today found some surprising news for Texas children. Even though the state continues to have the most uninsured children in the nation, the Lonestar State has made real progress in covering kids, with about a quarter of a million fewer uninsured children than it had four years ago. In fact, no state has seen as large of a positive swing in the number of children with health insurance.
“This is good news for children and the state of Texas since health insurance coverage greatly improves the economic security of families who are faced with tough budget decisions on a daily basis,” said Laura Guerra-Cardus with the Children’s Defense Fund – Texas. “Investing in our children’s health today helps create a strong workforce tomorrow since kids with coverage show up to school ready to learn and stay in school longer.”
Between 2009 and 2012, the number of uninsured children in Texas dropped by about 4 percentage points, with an estimated 256,000 children gaining coverage, according to data from the Georgetown University research center. A new report on improvements between 2010 and 2012 attributes the gains to the success of Medicaid and the Children’s Health Insurance Program (CHIP) in reaching uninsured children.
“Medicaid and CHIP are examples of federal-state partnership programs that work,” said Joan Alker, author of the Georgetown University CCF report. “Together they are improving health insurance coverage for children and are a testament to what states can accomplish when they lean in and work with the federal government to meet the needs of their residents.”
The Georgetown University CCF report found that in the state of Texas, about 84 percent of children had coverage, which is not as high as the 98 percent coverage rate for seniors, but better than the coverage rate for adults ages 18-64 in 2012. About two-thirds of working-aged adults have health insurance. Many of these adults fall into the so-called coverage gap, which means they would be eligible for Medicaid coverage if and when Texas accepts federal funds to improve that vital federal-state partnership.
A national survey released along with the Georgetown University CCF report found that getting all children covered is important to Americans. Almost nine out of ten (88%) surveyed said they wanted all children in their state to get covered.
“The truth is, as of this fall, nearly every Texas family can find health coverage for their children that fits with the family budget, now that new options are opening up in the Health Insurance Marketplace,” said Clayton Travis with Texans Care for Children. “That’s good news for everyone, as more kids will be able to stay healthy, show up for school and get ahead in life when they have the coverage they need.”
Families interested in finding out if their children qualify for Medicaid, CHIP or financial support with a new health plan in the marketplace should visit HealthCare.gov or call (800) 318-2596.
For earlier data from 2009 and 2011, read the Georgetown University Center for Children and Families prior report here.
Written by: Christine Sinatra, Texans Care for Children. Cross-posted at State of the Children blog.
Important news came out this week about Texas and its uninsured children. The Census Bureau released data on how many people have health insurance, as well as data on poverty and income levels. If we look at how our children’s health coverage fared there are two stories to tell. One is: Texas is doing better at enrolling our children in health insurance programs. The other is: We still need to do more, as evidenced by the fact that we have more uninsured kids than any state.
First, for the good news. According to an analysis of past Census data from The Urban Institute and funded by the Robert Wood Johnson Foundation, the rate of Texas children who are eligible for and enrolled in Children’s Medicaid or the Children’s Health Insurance Program (CHIP) has been steadily increasing. Texas had a participation rate in public insurance for children of just 75% back in 2008, but it climbed to 76% in 2009, and 80% in 2010, an earlier report showed; it was up to 82% in 2011, according to the latest report. The availability of these critical, affordable health insurance options cuts the number of uninsured children by hundreds of thousands in just a few years.
This is great progress that Texas can be proud of. Hard work within state agencies to make improvements to our CHIP and Medicaid system over the years, community partners working across Texas to enroll children and the efforts of people involved with the Connecting Kids to Coverage Challenge have all helped make this possible. Participation rates in the state are expected to continue to grow with implementation of the Affordable Care Act in 2014.
However, it isn’t all good news on the children’s coverage front. Texas has the highest overall number of uninsured children and of Medicaid- or CHIP-eligible kids not enrolled. In 2011, the Urban Institute report says, Texas children made up 15% of the nation’s total eligible but uninsured kid population. In fact, although our Medicaid and CHIP participation rate increased, it was still the eighth-worst among states.
Children not being able to get enrolled in the public health insurance options designed for them is an underlying cause for Texas’ high children’s uninsured rate overall. This translates to over 1 million Texas children without insurance of any kind, according to the Census’ Current Population Survey. This is a missed opportunity for all Texans. When children have healthcare coverage they are more likely to:
- stay healthier with regular checkups,
- get needed immunizations,
- be in school learning instead of home with a sickness and
- get medical care before a small illness can turn into a big one.
Opportunities through federal health reform will ensure that nearly every child has access to affordable coverage. Starting Oct 1, Texas families can enroll in coverage through the federally facilitated Health Insurance Marketplace. Financial assistance will be available to make coverage fit with families’ budgets, even for the families who have traditionally been priced out of the market.
There are also a number of changes coming for families enrolling their children (or expectant moms) in Medicaid and CHIP. The Affordable Care Act is cutting some of the red tape that stood between families and the coverage they need for their children—meaning kids who were once denied services might be able to get help now, and stay covered, too.
Finally, if Texas gets smart and decides to allow low-income hard working parents to enroll in Medicaid, studies show that their children are more likely to be enrolled and stay enrolled. The pieces are there to give all children the healthcare coverage they need. It’s up to state leadership to put them together.
Written by: Clayton Travis, Texans Care for Children. Cross-posted from State of the Children blog.
Despite Texas elected officials’ current—and regrettable!—decision to exclude the poorest uninsured adult Texans from coverage in 2014, there are some important Medicaid changes afoot here for 2014. In fact, all 50 states are making these changes, no matter what their current decision on adult Medicaid expansion. Texas Health and Human Services Commission’s staff certainly know it; they have put in plenty of long hours over the last year planning and prepping for these changes.
Here are some of the big-picture changes for 2014:
- There will be a single application (paper, phone, or online) that can be used in every state to apply for Medicaid, CHIP (Children’s Health Insurance Program), or to get lower-cost coverage in the individual Health Insurance Marketplace. (Compare today: 50 states, 50 different applications.) States can also customize their own application (with federal approval), but must accept both the federal and the state version.
- All 50 states will use the same income counting rules. The new rules are generally based on how the IRS figures “adjusted gross income” for federal income taxes, but with some adjustments that are designed to protect current Medicaid coverage. For example, income of grandparents or other non-parent relatives who are raising children will remain uncounted when determining Medicaid eligibility for those children—even if the children are treated as dependents on their grandparents’ tax return.
- “Asset tests” will end for Medicaid children, parents, pregnant women, and CHIP kids. Looking beyond income to tally up not only money in the bank but also the value of possessions and vehicles will end in 2014. All but four states had already dropped these “resource tests” for children, but Texas still used them and over half the states still applied them to parents seeking Medicaid. (Note: Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, will still look at assets when applying for medical care and long term care benefits.)
- Face-to-face interviews to apply or renew will no longer be required. Almost all states have already dropped mandatory in-person application and renewal interviews for children’s and parent’s Medicaid and CHIP, and in 2014 all states will retire those requirements. Importantly, though, in-person and telephone application assistance will remain an option in every state for those who prefer it. (Note: Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, may still require interviews.)
- Electronic Verification tools will be used to the greatest possible degree. Medicaid, CHIP, and the new Health Insurance Marketplace are all expected to rely on electronic databases (employer/wage, new hire, Social Security, IRS, vital statistics, etc.) to the maximum degree possible to verify eligibility criteria for health care benefits( e.g. income, residence, citizenship, and immigration status). It is likely that families with lots of monthly variation in hours of work and dollars earned will still face additional paper documentation requirements. Still, many families will be able to avoid having to collect and submit numerous documents, and a growing percentage will have their eligibility determined in “real time.”
- Former Texas Foster Children will be eligible for Medicaid until they turn 26. Because the ACA allows young adults to stay on their parents’ health plan until age 26, Congress tried to create a parallel opportunity for youth “aging out” of foster care who would not otherwise have the same chance for coverage.
- Medicaid renewal will be required only once every 12 months. Children, parents, and adults without dependent kids (in the states that have expanded coverage to adults) will only have to renew eligibility once a year. Importantly, there is a difference between a 12-month renewal period and 12-month “continuous” eligibility; the latter means persons need not report income changes during the 12-month period. States like Texas that do not offer 12 months of continuous eligibility for children in Medicaid (we provide 6 months), and which have no continuous coverage for the small number of parents we cover on Medicaid, will likely still require families to report changes in income that occur during the 12-month period—at least in the near term.
- CHIP kids 6-18 from 100-138 percent FPL will move to Medicaid. Texas and most states have had a perplexing stair-step eligibility set up for children, leaving some families with preschool-aged kids in Medicaid while their school-aged kids in CHIP. In 2014, most of the stair-step will be removed, so that all kids (age 1 through 18) with family incomes under 138 percent of the federal poverty level (FPL) will enroll in Medicaid, and those from 138-200 percent FPL will get CHIP coverage. Texas plans to re-sort the currently enrolled CHIP kids when they first come up for renewal in 2014. (Note: infants up to their first birthday will still be covered in Medicaid up to 185 percent FPL, the same income cap that applies for women’s maternity coverage.)
To get involved and stay informed on developments in the Medicaid-CHIP eligibility system, and its interface with the new Health Insurance Marketplace, join the Texas CHIP Coalition.
Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from the Better Texas blog.
Millions of Texans rely on Medicaid and CHIP (Children’s Health Insurance Program) for their health care coverage.
Unfortunately, the 2014-15 state budget fails to undo the deepest cuts made to these vital services in 2011 and is marked by both new and ongoing austerity measures. Our state’s inability to pay frontline health care workers a living wage, or keep Texas Medicaid provider payments on par with Medicare, parallels Texas’ struggle to adequately fund our other most basic needs.
Most senseless of all, state leaders missed an opportunity to draw down billions in federal Medicaid funds through the Affordable Care Act and provide health care to our poorest uninsured.
As a result, come January 2014, Texas adults living below poverty, like Melissa, a 41-year-old mom from Austin, will remain uninsured. Melissa is a self-employed artist and relies on CHIP for her son’s care, but neither she nor her husband are insured and they don’t qualify for Medicaid under current rules.
“Medicaid Expansion would give my family health insurance coverage we currently don’t have,” she says. “It would give me the security and peace-of-mind to know that the event of an illness or accident would not put an additional financial burden on my family.”
Read Anne’s analysis of what happened, and didn’t happen, with Medicaid and CHIP in the 2014-15 budget.
Cross-posted from Better Texas Blog. Alexa Garcia-Ditta and Anne Dunkelberg, Center for Public Policy Priorities
“Health of Texas Children Improving, Surveys Show,” read a headline this week in the Dallas/Fort Worth publication D HealthCare Daily. The report goes on to say the National Survey of Children’s Health–from 2003, 2007 and 2011-2012–indicates progress for Texas kids “on several health-status measures, (including) a significant uptick in mental-health screening and diagnosis for children in recent years.”
What else is noteworthy from the study:
- Children reported to be in excellent or very good health in Texas climbed 5 percentage points to 82% in the last decade.
- Children who received a check-up in the past year climbed 8 percentage points to 83% over the same time period.
- Parents reporting their children were breastfed at any time climbed 6 percentage points.
- The rate of children receiving developmental screenings tripled from 2007 to 2011.
What can cause improvements like that? No doubt, a lot is a lot at play. But, with swings so large, public policy is often a part of the story.
Here in Texas, between 2003 and 2011, our state shored up Children’s Medicaid and CHIP, cutting red tape in two systems that help kids throughout Texas see a doctor when they need to. The result? The number of uninsured children fell by hundreds of thousands in recent years, even as our overall child population grew. We still lag behind most of the nation in insuring kids, but Texas has made progress.
(For how Texas compares to the nation as a whole on the survey findings, see this snapshot from the Data Resource Center for Child and Adolescent Health.)
It is nice to see as more kids got covered, more families reported good news about their children’s health.
I took a dive this morning into just-released new Census numbers on uninsured in Texas and the nation for 2011. Sorry for the blizzard of numbers, but I’ll try to make them paint a picture!
No surprise, Texas still has the worst uninsured ranking in the country, with 6.08 million uninsured (23.8% of all Texans). This is a teeny bit better than last year’s 24.6% uninsured rate—just barely “statistically significant.”
But the picture remains brighter for Texas kids, whose uninsured rate is stable at 16.3% of kids under age 19 (1.2 million uninsured Texas kids). Only in Texas could we celebrate moving to 49th from last place, but Nevada has now solidly claimed the worst-kids’-coverage spot with their 19.3% child uninsured rate.
Of course, 1.2 million uninsured children is nothing for Texas to applaud—we have about 9 uninsured children for every one in Nevada.
Another interesting factoid: of our 1.2 million uninsured Texas children, around 740,000 are children under the CHIP income cap who are either US citizens or legal residents. That means—you guessed it—they could be enrolled in Medicaid or CHIP, but they aren’t! So, clearly we still have loads of work to do educating Texas parents about their options and making it easier than ever for eligible kids to get care and keep their care.
Forgive me if I can’t resist talking a little bit about our Texas parents who lack health coverage. Texans are much less likely to get health care through their job (or spouse or parent’s job) than in the US as a whole. Barely over half of Texans are covered this way 50.6% (compared to US 55.1%). And, working-age adults here have an uninsured rate that is nearly twice what our kids face: 30.9% or nearly one in three adults 19 to 64. The why is simple; Medicaid and CHIP are there for our poor and low-income kids, but Texas adults don’t have those options.
Other signs on my deep dive of the importance of Medicaid and CHIP for children: both the number and percentage of Texas kids with private insurance has dropped in the last four years, but the number and percentage of kids with Medicaid and CHIP has taken up the slack. The only group of Texas children whose uninsured rate went up was those kids just over the CHIP limit, in families between 200-300% FPL.
There is some good news about “really big kids, ” too: uninsured rates improved significantly for Texans 19-25 since 2010, who now have new options to stay on a parent’s health plan until they hit their 26th birthday. You can really see the impact in the numbers, because the uninsured rate for Texas adults 26-64 did not improve at all.
O.K., time to dive back into the numbers again. Stay tuned for an update on how Texas uninsured would fare under the ACA’s private and public health coverage options in 2014!
Written by: Anne Dunkelberg, Center for Public Policy Priorities
Today is the third anniversary of bipartisan legislation that strengthened the Children’s Health Insurance Program, known in Texas as CHIP. This anniversary provides a great opportunity to reflect on our progress and highlight the important successes we have to celebrate when it comes to extending health coverage to all children.
In the three years since CHIP’s reauthorization, the nation has made historic gains in covering kids. Thanks to CHIP and Medicaid, over 3 million Texas children can get the checkups and preventive care they need to stay healthy and see the doctor when they get sick or injured. Children across the country have benefitted from the law. In the past year alone, 25 states have reduced the red tape in their CHIP and Medicaid programs, so that more kids can get covered. While we won’t consider the job done until every child is covered, there is progress to celebrate: between 2007 and 2011, more than 800,000 formerly uninsured Texas children gained coverage.
One of the main reasons for these impressive gains in coverage happens behind the scenes: Texas’s Health and Human Services Commission, the agency responsible for processing paperwork for CHIP and Medicaid, has made great strides in improving efficiency and accuracy in the enrollment process for families. In Texas, we have cut red tape. Our state was once among the nation’s worst offenders for unnecessary processing delays and errors that left families who qualified for Medicaid or CHIP and played by all the rules, nonetheless, without access to health care for their children. Today, Texas is one of the country’s most improved states for processing benefits—something we can all be proud of. It means we are living up to our promise to families with children who need to see a doctor.
The “maintenance of eligibility” requirement in the health reform law has also helped countless Texans. The rule provides important stability for families facing economic uncertainty by ensuring states like Texas keep enrollment procedures that are already working for our families on the books.
And CHIP and Medicaid help more than just the families whose children receive care through the program. CHIP and Medicaid strengthen our economy. If Texas can make improvements to and enroll more children in CHIP, the state can begin to qualify for an annual Performance Bonus, which puts federal tax dollars back into our economy and protects local jobs.
We are encouraged by the progress that has been made but recognize that there is still more to do. We are working with state leaders to ensure that CHIP and Medicaid help even more uninsured children get the care they need to grow and thrive in 2012. Let’s celebrate this anniversary by committing to keep building on its success.
Contributed By: Christine Sinatra, Austin, TX