The AAP has outlined a new vision for Medicaid and the Children’s Health Insurance Program (CHIP), which provide essential health care coverage for about half of U.S. children and young adults.
Building on the major public investment in the health of children and youths, a new AAP policy statement calls for combining Medicaid and CHIP into a broad national program supporting the provision of individualized, family-centered, equitable and comprehensive care. This vision is based on the AAP commitment for all children to have access to health care that supports their optimal growth, development and well-being.
The policy Medicaid and the Children’s Health Insurance Program: Optimization to Promote Equity in Child and Young Adult Health, from the Committee on Child Health Financing, is available at https://doi.org/10.1542/peds.2023-064088 and will be published in the November issue of Pediatrics.
A forthcoming technical report will expand on the origins and intents of the Medicaid and CHIP programs, the current state of the programs, including variations across states and payment structures, and other background.
Programs’ strengths, concerns
The Medicaid and CHIP programs insured over 50% of all U.S. children and youth prior to the “unwinding” process that allowed states to disenroll individuals from Medicaid when the public health emergency ended. No other age group except the older population on Medicare is so dependent on public insurance.
Children of Black/African American or Hispanic/Latino background have high representation among Medicaid and CHIP beneficiaries, and these programs help to improve equity in health care access for many children otherwise at risk of being uninsured.
Medicaid’s strengths include no waiting periods or co-pays and the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit requiring states to provide a broad array of services. Thus, many children insured by Medicaid have the opportunity to have good short- and long-term health outcomes.
The Medicaid and CHIP programs also have key limitations. These include the joint federal and state financing system, leading to state-by-state variations in eligibility, enrollment, covered benefits, scope of coverage, payment and quality standards. Additionally, Medicaid and CHIP have different rules and governance, as well as different federal/state match rates, benefits and eligibility.
Program variations lead to inequities and barriers to primary and specialty care. Variations also affect families who need to navigate different programs, including re-enrollment processes, and pediatricians who may see patients across state lines.
Vision for single program
The AAP endorses a Medicaid and CHIP program that fully addresses the health and health care needs of diverse children and youths equitably, helping to ensure their optimal growth and development. Care should be provided based on children’s and family’s needs, not on where they live.
Achieving this vision requires foundational changes in three main areas:
- eligibility and duration of coverage,
- standardization of covered services and quality of care, and
- program financing and payment.
To achieve these goals, the statement recommends the following:
- combine the Medicaid and CHIP programs into a single program to allow for consistency between programs,
- provide major increases in the federal share of funding for these programs with continued state flexibility for innovation,
- end decades of underpayment, with program payments at least in parity with Medicare rates,
- enroll all newborns and maintain continuous enrollment until an individual is 26 years old or opts out of the program,
- strengthen EPSDT and enforce it as a national standard of care and quality, and
- conduct health equity assessments of Medicaid-CHIP that create a system of accountability to help avoid introducing new harms or perpetuating existing damage and to close equity gaps.
The foundational and stepwise changes outlined in the policy statement should help guide policymakers to strengthen the Medicaid and CHIP programs with the goal of improving health care and access for all children.
Dr. Kusma is a lead author of the policy statement. She is a member of the AAP Committee on Child Health Financing.
