Health Insurance for Children:

Many Remain Uninsured Despite Medicaid Expansion

HEHS-95-175: Published: Jul 19, 1995. Publicly Released: Aug 2, 1995.

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Pursuant to a congressional request, GAO reviewed the status of health insurance for children, focusing on: (1) the impact of the Medicaid expansion on children's health insurance coverage since 1989; (2) changes in the demographic profile of children enrolled in the Medicaid program and uninsured children since the Medicaid expansion; and (3) the number of uninsured children who might be eligible for Medicaid.

GAO found that: (1) policy changes helped increase the number of children enrolled in Medicaid by 4.8 million between 1989 and 1993, but the overall number of uninsured children did not decline because employment-based coverage for adults and children declined during the same period; (2) children were not as affected by the loss of employment-based insurance as adults because of expanded Medicaid coverage; (3) the percentage of poor children who were uninsured declined from 25 percent in 1989 to 20 percent in 1993, while the percentage of near-poor children who were uninsured increased during that time; (4) the Medicaid expansion increased the enrollment of children less likely to be on Medicaid and by 1993, more than half of Medicaid children had a working parent and almost half were not receiving Aid to Families with Dependent Children benefits; (5) the greatest increase in coverage was among children with at least one full-time working parent; (6) the South region had the greatest increase in the number of children enrolled in Medicaid, although it still has the greatest number of uninsured children; and (7) at least 2.3 million uninsured children were eligible but not enrolled in Medicaid because their parents were unaware of their eligibility or had difficulty in applying for Medicaid coverage.

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