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Health Insurance for Children and Young Adults

August 28, 2023

Editor’s Note: Beth Dworetzky's son was born with a complex heart condition. She and her son navigated a fragmented health care system for 31 years until his death in October 2021. -Cara L. Coleman, JD, MPH, Associate Editor, Pediatrics

Family Connections with Pediatrics blog

Children are not small adults. When it comes to their well-being, their insurance must cover the types of health care providers and services they need. It must also be affordable and not cause family financial hardship.  

At the start of the COVID-19 pandemic public health emergency (PHE), more than 6 in 100 children in the US did not have health insurance. During the PHE, state Medicaid and Children’s Health Insurance Programs (CHIP) provided ‘continuous eligibility’ for children who were already enrolled–they did not check that they still met the income and medical need guidelines. In addition, more children were able to enroll in Medicaid, CHIP, or Affordable Care Act Marketplace plans for the first time. These expansions helped reduce the number of uninsured children to fewer than 5 in 100.

When the COVID-19 pandemic PHE ended on May 11, 2023, states began a process called ‘redetermination’ to check if people were still eligible based on household income, children’s ages, and medical need. This process may cause the number of children without health insurance to rise again.

In its updated Policy Statement, “Principles of Child Health Care Financing,” published in Pediatrics this week, the American Academy of Pediatrics looks at the importance of quality and affordable health insurance for children, birth to age 26 in the US (10.1542/peds.2023-063283).

What is the policy statement about?

The new policy lists 6 central features for designing health insurance for children.   

  1. Universal coverage despite family income, immigration status, or preexisting health needs.
  2. Insurance should cover the services that children need.
    • Insurance should provide prenatal and newborn care, well-visits, emergency care, and all medically necessary services, including mental and behavioral health services.
    • Services should be the same, no matter where children live or how they are insured.
    • Insurance networks must include pediatric specialty providers.
    • Insurance should pay the same amount for telehealth and in-person visits.
  3. Insurance should be affordable so care is not delayed.
    • Out-of-pocket costs, especially for medication, should not cause a financial burden.
  4. Insurance payments should support the medical home to ensure better care, lower costs, and better experience of care.
    • Identify ways to provide care in rural and frontier locations, such as telehealth or at rural health centers, school-based health centers, or other community spaces.
    • Pay for transition from child to adult health services.
  5. Insurance should promote equity.
    • There should be an increase in Medicaid reimbursement rates.
    • Medicaid and CHIP insurance coverage should be provided to all children, even if documentation status is not known.
    • Insurance should ensure payment for medical interpretation and translation.
    • Insurance enrollment forms should be available in many languages.
  6. Financing must consider children’s needs.
    • Insurance should pay to screen for and assess social drivers of health, the features of where children live that can affect their health. Examples include safe housing and neighborhoods, access to public transportation, healthy food, air and water quality, racism, and violence.

How can families use this information?

  1. Read the policy and share it with your child’s doctor.
  2. Learn about strategies to ensure continued coverage for children now that the COVID-19 PHE has ended.
  3. If you or your child have Medicaid or CHIP, watch your mail for forms to reenroll and respond as soon as you get them. Even if you are no longer eligible, your child may still be. If you do not understand the forms, contact the Medicaid or CHIP program in your state or contact the family-to-family health information center in your state, territory, or tribal nation for help navigating public and private health insurance.
  4. Read about the health financing strategies some states use to cover more services and reduce family financial hardship.
Learn about child health services and health insurance coverage in your state compared to other states.
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