It’s Time to Cover All Kids

Every child should have every opportunity for a healthy start, and that includes having access to comprehensive health coverage. Unfortunately, roughly 96,500 (4.9%) children in Virginia do not have health coverage according to 2019 census data.¹ This could mean missed opportunities for early medical intervention, absences from school due to illness, and families avoiding medical care due to fear of financial cost. Lack of health insurance could have an outsized impact on the educational, health, and financial wellbeing of children and their families. 

While there has been some recent improvement in children’s insurance rates in Virginia, the state still ranks 25th in the nation for the number of children who do not have health insurance.² A closer look at the data makes it clear that children who are either Latinx, immigrants, or from families with low to moderate incomes face significant barriers to health coverage.

State lawmakers can and should do more to make sure affordable and comprehensive health coverage is available to all children who call Virginia home. Increasing eligibility levels for the state’s health programs and removing barriers related to immigration status would provide an affordable health coverage option to roughly 1 in 3 (31%) children in Virginia who are currently ineligible and uninsured. 

Who are Virginia’s uninsured children?

Virginia’s uninsured rate for children dropped from 5.1% in 2018³ to 4.9% in 2019.⁴ This was largely due to the implementation of Medicaid expansion and what is known as the “welcome mat” effect: when parents become eligible for health coverage, they are more likely to sign their children up as they learn more about eligibility rules.

This small improvement in health coverage for children is a step in the right direction but a closer look reveals unequal access to coverage based on race/ethnicity. Latinx children are significantly overrepresented in the number of uninsured children. While only making up 14% of the child population (aged 0-18) in Virginia, Latinx children account for 35% of all uninsured children in the state.⁵

Children in families with low or moderate incomes are also more likely to be without coverage. While children in families earning above 305% of the federal poverty level ($66,978 for a family of three) have an uninsured rate of just 2.5%,⁶ children in families earning less than that level have an uninsured rate of 7.4%.⁷ To provide more children with the opportunity of a healthy start, families with low and moderate incomes must have greater access to affordable and comprehensive health coverage options.

A child’s immigration status is also a strong indicator of whether or not they have health coverage. Children who are citizens have an uninsured rate of 4.1%, while children who are non-citizens have an uninsured rate of 31.3%.⁸ Non-citizens vary in current immigration status, including lawful permanent residents, refugees and asylees, those with pending immigration cases, those without any status, and many other possible immigration statuses. The stark contrast in uninsured rates is largely because many non-citizens, particularly undocumented immigrants, face several barriers to accessing health insurance.

Lawmakers in Virginia should build on recent progress to provide affordable health coverage options to the youngest Virginians who call the state home. Expanding coverage options for low and moderate income families and children regardless of immigration status is an important next step. 

Virginia’s Eligibility Rates Lagging Behind 

The maximum income that a family can earn in Virginia and still be eligible for health coverage through Medicaid or the Children’s Health Insurance Program (Medicaid/CHIP) is low. With an income limit set at 205% of the federal poverty level (FPL)⁹ — $45,018 for a family of three¹⁰ — Virginia is tied for 44th lowest in the nation along with four other states (AZ, NV, UT, and WY). Only two states, Idaho and North Dakota, have more limited access to their public children’s health insurance programs than Virginia.¹¹

Our current eligibility lags behind the national median upper-income limit (255% FPL) and the median limit for states that have expanded Medicaid (266% FPL). Virginia should modernize eligibility standards and join 19 other states that cover children at or above 300% FPL.¹²

Increasing eligibility to 305% FPL ($66,978 for a family of three)¹³, would mean roughly 18,650 children who are citizens and currently uninsured and not eligible for Medicaid/CHIP in Virginia could be connected to new affordable health coverage.¹⁴ This represents nearly 1 in 5 (19%) currently uninsured children in Virginia.¹⁵

While raising income eligibility limits could provide a significant boost in the goal to cover all children in Virginia, efforts to provide affordable coverage to all children regardless of immigration status should also be prioritized.

Covering Children Regardless of Immigration Status

Six states (CA, IL, MA, NY, OR, and WA) and the District of Columbia use state-only funds to cover income-eligible children in Medicaid/CHIP who are otherwise ineligible due to immigration status.¹⁶ These states all have a lower children’s uninsured rate than Virginia (4.9%) ranging from 1.5% to 4.1% and have modeled how this coverage expansion can be effective at lowering uninsured rates for children.¹⁷

Though funded primarily with state-only dollars, these state coverage programs function just like Medicaid/CHIP for the family, offering the same scope of child-specific benefits. Virginia should follow suit by expanding Medicaid/CHIP coverage to all children regardless of status.

By increasing the Medicaid/CHIP income eligibility cap and expanding the program to all children regardless of status, over 30,200 children¹⁸ currently uninsured and ineligible for Medicaid/CHIP would have new access to affordable and comprehensive coverage. This policy change would provide a new and affordable health coverage option to roughly 1 in 3 (31%) uninsured children in Virginia.¹⁹

Conclusion

State lawmakers have made recent progress in expanding access to affordable and comprehensive health insurance but more can be done to make sure Virginia’s youth are covered. Investments in Virginia’s children will help make sure more families can meet their health needs without risking their financial well-being. It’s time to cover all kids and become a national leader for children’s health coverage.

Endnotes

1. U.S. Census Bureau – American Community Survey, “Selected Characteristics of Health Insurance Coverage in the United States” 2019
2. Alker, J. and Corcoran, A., “Children’s Uninsured Rate Rises by Largest Annual Jump in More Than a Decade,” Georgetown University Health Policy Institute, Oct 2020, page 14
3. U.S. Census Bureau – American Community Survey, “Selected Characteristics of Health Insurance Coverage in the United States” 2018
4. U.S. Census Bureau – American Community Survey, “Selected Characteristics of Health Insurance Coverage in the United States” 2019
5. TCI analysis of IPUMS 2019 ACS1 Census Microdata
6. TCI R analysis of 2019 ACS Census Microdata Note: SHADAC’s HIU variable was used to more closely match how Medicaid and ACA enrollment defines a family for income eligibility purposes. For more information visit: SHADAC’s Health Insurance Unit 2020 Update: HIU Code
7. TCI R analysis of 2019 ACS Census Microdata Note: SHADAC’s HIU variable was used to more closely match how Medicaid and ACA enrollment defines a family for income eligibility purposes. For more information visit: SHADAC’s Health Insurance Unit 2020 Update: HIU Code
8. TCI analysis of IPUMS 2019 ACS1 Census Microdata
9. “Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level” Kaiser Family Foundation, Jan 2021
10. “HHS Poverty Guidelines for 2021” U. S. Department of Health and Human Services, Jan 2021
11. “Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level” Kaiser Family Foundation, Jan 2021
12. Brooks, T., Gardner A., Tolbert, J., Dolan, R., and Pham, O., “Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey,” Kaiser Family Foundation, Jan 2021
13. “HHS Poverty Guidelines for 2021” U.S. Department of Health and Human Services, Jan 2021
14. TCI R analysis of 2019 ACS Census Microdata Note: SHADAC’s HIU variable was used to more closely match how Medicaid and ACA enrollment defines a family for income eligibility purposes. For more information visit: SHADAC’s Health Insurance Unit 2020 Update: HIU Code
15. TCI analysis of IPUMS 2019 ACS1 Census Microdata
16. Whitener, K. “COVID-19 and Immigrant Health” Georgetown University Health Policy Institute, Apr 2021
17. U.S. Census Bureau – American Community Survey, “Selected Characteristics of Health Insurance Coverage in the United States” 2019
18. All children uninsured from 206 FPL-305 FPL:TCI Analysis of IPUMS ACS Census 2019 Microdata Undocumented and uninsured children under 205% FPL: Migration Policy Institute analysis of U.S. Census Bureau data from the 2014-18 American Community Survey (ACS) pooled and the 2008 Survey of Income and Program Participation (SIPP), weighted to 2018 unauthorized immigrant population estimates provided by Jennifer Van Hook of The Pennsylvania State University, Population Research Institute.
19. TCI analysis of IPUMS 2019 ACS1 Census Microdata

Categories:
Health Care, Immigration