Expand Economic Opportunity and Reduce Child Poverty

Health Care

Health insurance is a key determinant in a family’s ability to access adequate health care. [i] Studies show that states that do not help families access preventive health care often pay much greater amounts for emergency rooms and hospitalization when a preventable ailment becomes a major disease. [ii] States can promote the stability of the work force and potentially reduce long-term costs to government by expanding access to health insurance.

What Can Policymakers Do?

• Expand Parent Eligibility for Medicaid. Parental health insurance coverage is not only important for a parent’s own health, research indicates that parental coverage is a strong predictor of a child’s use of health services. [iii] When parents lack health care coverage it compromises their ability to stay on the job and work toward economic self-sufficiency. [iv]

States determine the income eligibility level for parents separately from decisions about children’s eligibility. Full Medicaid coverage is available to parents with incomes at or above the poverty line in 16 states; an additional eight states have extended more limited coverage to poor parents through waivers or state funds. [v]

States are required to extend Medicaid eligibility to children under 6 years old living in families with incomes at or below 133 percent of poverty, and to children ages 6-18 living in families with incomes at or below 100 percent of poverty. Low-income, recent immigrant children and undocumented children are barred from federally-financed public coverage. Ten states and the District of Columbia provide coverage above 250 percent of poverty. An additional eight states have income thresholds greater between 200 percent and 250 percent of poverty. Twenty-five states have upper income limits at 200 percent FPL. Seven states set maximum income levels below 200 percent FPL. [vi]

Additional resources:

• The National Academy for State Health Policy provides provide details on current state health insurance plans
• Recent state developments.
• A 50-state map on state health insurance policy, including eligibility levels for parents.

• A summary federal stimulus provisions related to Medicaid prepared by the the Center on Budget and Policy Priorities.

• Reduce premiums, copayments, and deductibles. While states have been working hard to expand public health insurance options for low-income families, too often financial and administrative barriers prevent families from enrolling. States sometimes require cost-sharing by eligible families through premiums, co-payments and deductibles. States pursue cost-sharing to provide incentives against overuse of health care and to limit health care costs, but research shows that even small fees can reduce patient access to care. [vii]

Under Medicaid rules, states are prohibited from asking low-income children pregnant women to share the costs of Medicaid. Under SCHIP, states can institute cost-sharing policies. Research indicates that premiums and co-payments can reduce enrollment and health care service usage among poor families. [viii]

See an exploration of cost sharing in public health insurance programs.

• Reduce administrative barriers. According to research by the Kaiser Commission on Medicaid and the Uninsured a complex burdensome enrollment process is the greatest barrier to enrolling in public health insurance programs. [ix] States can do much to reduce barriers including:
• Shorten application form and need for excessive documentation
• Eliminate face-to-face interviews
• Increase availability of enrollments points through more accessible enrollment offices, use of nonprofit partners to handle enrollment, and use of on-line application technology.
  

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