The Children Left Behind

While Medicaid's benefits seem endless, many may question why so many children do not have the health insurance that they so desperately need. When Medicaid was separated from welfare during the mid-1980s the hope was that children would benefit from major eligibility expansions. But state eligibility procedures have been shaped over time by federal rules that penalize states for enrolling ineligible beneficiaries, and the AAP indicates that there has been silence about the millions of eligible beneficiaries who are not enrolled. Beginning with the passage of Title XXI, the AAP has put a call out to pediatricians, other health-care professionals, and child advocates to assist state Medicaid agencies in providing outreach to families whose children are uninsured or underin-sured.

In the United States there are specific groups of children that are at an especially high risk for being without health insurance. A national survey in 1998 found that teens, children of color, and children in single-parent families were at a particularly high risk for being uninsured. Other research also indicated that the educational status of adult family members is a good predictor of a child's insurance status. For in stance, parents who have not completed high school are likely to work in unskilled jobs lacking health insurance benefits, and therefore their children are most likely to be without health coverage. The Census Bureau reported that black children had a higher rate of Medicaid coverage in 1999 than children of any other racial or ethnic group. The rate for black children was 36.2 percent, compared with 30.8 percent for Hispanic children, 16.7 percent for Asian and Pacific Islander children, and 13.2 percent for white non-Hispanic children.

In order to increase enrollment in Medicaid, President Clinton in 1998 launched the Children's Health Insurance Outreach Initiative, which gave the states additional funds and flexibility to find and enroll hard-to-reach children. President Clinton's initiative also challenged the public and private sectors to educate families about Medicaid and SCHIP. An additional step taken by the Clinton administration was the nationwide ''Insure Kids Now'' campaign in 1999 to enroll eligible children in Medicaid and SCHIP.

While Title XXI is a significant progression for U.S. social policy by offering a way to reduce the number of children who are uninsured, there are many variables that must coincide for the program to be successful. The biggest issues that remain are: reaching those who are eligible for Medicaid and educating families about the importance of health insurance for their children.



American Academy of Pediatrics. "Implementation Principles and Strategies for the State Children's Health Insurance Program.'' Pediatrics 107 (2001):1214-1220. American Academy of Pediatrics, Committee on Child Health Financing. ''Medicaid Policy Statement.'' Pediatrics 104 (1999):344-347.

Health Care Financing Administration [web site]. Boston, 2001.

Available from; INTERNET. Perloff, Janet D. ''Insuring the Children: Obstacles and Opportunities." Families in Society: The Journal of Contemporary Human Services (September 1999):516. U.S. Bureau of the Census. ''Health Insurance Coverage: Consumer Income.'' Washington, DC: U.S. Bureau of the Census, 1999.

Beth A. Kapes

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