Medicaid and CHIP

In Process

GAO's analysis of Medical Expenditure Panel Survey results found that children were more likely to have insurance if their parents had insurance and were more likely to be uninsured if their parents were uninsured. GAO's analyses further identified a strong association between a parent's health insurance status, defined as privately insured, publicly insured, or uninsured, and a child's health insurance status. Specifically, 84 percent of the children in GAO's analysis had the same insurance status as their parents, while 16 percent of children did not. The association GAO identified remained despite variation in factors such as age and family income. However, a parent's insurance status was not consistently associated with a child's use of services or parental satisfaction with their child's care. In most cases, a child was equally likely to have used services, or to have received satisfactory care, regardless of the parent's insurance status. Health insurance coverage expansions required under PPACA will prompt states to change parental coverage in Medicaid- and CHIP-funded programs, but the extent of state changes will vary. By 2014, PPACA requires states to extend Medicaid eligibility to most adults under 65, including parents, with incomes up to 133 percent of the federal poverty level (FPL); PPACA also requires the establishment of exchanges in each state through which parents and others who are not eligible for Medicaid can purchase health insurance. States' implementation of PPACA will depend on their unique circumstances, including the extent of the expansion of coverage necessary. However, the association between parents' and children's health insurance status could result in newly eligible parents enrolling their children in Medicaid. Similar expansions of parental coverage through the exchanges could also increase the number of insured children. CMS guidance will be critical to facilitate states' efforts to comply with these requirements.