Policies aimed at improving children’s access to coverage will keep more kids connected to Medicaid and CHIP benefits and keep costs down
HARRISBURG (November 19, 2024)—The number of uninsured children in Pennsylvania remains stable following last year’s unwinding of the Medicaid continuous coverage provision, but no progress has been made, according to the State of Children’s Health report by Pennsylvania Partnerships for Children. The report provides the first look at the impact of resuming Medicaid renewals following a three-year federal hiatus during the COVID-19 public health emergency.
Between 2022 and 2023, the rate of Pennsylvania children without health insurance remained steady at 5.2%. However, steady rates do not mean progress. Too many children live in Pennsylvania without access to health insurance. The number of Pennsylvania children under age 19 without health insurance increased slightly from 145,000 to 147,000 from one year ago.
“Pennsylvania continues to have the 5th highest number of uninsured children in the nation, with 147,000 children—more than the entire population of Lebanon County—without health insurance,” said Kari King, President and CEO of Pennsylvania Partnerships for Children. “While the Medicaid unwinding process did not cause significant disruptions to children’s coverage in 2023, we will know next year if there were disruptions in 2024 as the process wrapped up in June.”
Medicaid is the largest source of health coverage for children with more than 1.2 million Pennsylvania children enrolled. Children with Medicaid coverage have access to health insurance that connects them to doctor visits, immunizations, and well-visits that screen for physical and mental health. It is also an essential source of coverage for Pennsylvania children with disabilities, those living in low-income families, and those living in and aging out of foster care.
Like most states, Pennsylvania used a year-long process to unwind the disenrollment freeze and resume regular pre-pandemic eligibility and enrollment operations. Approximately 8 out of 10 children with renewals completed within Medicaid unwinding maintained public coverage. A negative takeaway is that 42% of children who were disenrolled were due to administrative reasons, not eligibility.
King said these procedural disenrollments occur too often. The report recommends that the state improve automated “ex parte” renewals instead of enrollees submitting renewal applications. Pennsylvania has a poor track record using automatic renewals, coming in at the lowest percentage of any other state.
The report also recommends strengthening the state’s continuous eligibility (CE) policy. Continuous eligibility provides more access to preventive care and continuity of care and treatment, fewer missed medications, and fewer disruptions due to difficulty navigating the renewal process or fluctuations in monthly income and reduces administrative burdens of enrollment churn.
Beginning in January 2024, states were required to provide 12 months of CE—a full year of coverage regardless of changes in circumstances—for children under age 19 in both Medicaid and CHIP.
King said in January 2024, the Pennsylvania Department of Human Services submitted a waiver application to provide continuous Medicaid coverage from birth until age 6. Child advocates, providers, and children’s hospitals encouraged and supported the plan. In a big win for kids, DHS has received federal approval of its plan to provide Medicaid continuous coverage for Pennsylvania’s youngest children, which is expected to start in January.
Approximately 47% of Pennsylvania children rely on Medicaid, CHIP, or Pennie™ health plans to meet their health care needs. King said a growing concern is that the Pennie™ “no wrong door” policy may not be working as intended, as 58% of children enrolled through Pennie™ appear financially eligible for Medicaid or subsidized CHIP programs.
Though it is commendable that these children are not going without health insurance, families must understand their options and be appropriately enrolled in a program based on eligibility. Proper enrollment will provide more cost savings and prevent families from incorrectly receiving federal tax credits or subsidies. Individuals eligible for CHIP or Medicaid do not qualify for financial assistance through the marketplace.
“One child without health insurance is too many,” King said. “Strengthening automated renewals and providing continuous coverage to young children, along with improving our ‘no wrong door’ policy, will help ensure no child is disconnected from care and will keep down costs for families and the state.”
According to the report, factors such as race and ethnicity, poverty level and geographic region impact children’s access to health insurance. Demographic highlights include:
- From 2022, uninsured rates remained the same for children under age 6 (5.6%) and school age children (5.1%), and children under 6 are more likely to be uninsured.
- By race, American Indian and Alaska Native children and White children saw the biggest improvements in their uninsured rates from 2022 to 2023, while uninsured rates worsened for Asian children, Black children, Hispanic children, and children of multiple races.
- Children in lower income levels did worse and children in higher income levels did better. Children in lower-income families are more likely to be uninsured, and approximately 6.8% of PA children are financially eligible for Medicaid but not enrolled.
King said accompanying fact sheets for each of the 67 counties show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.
For more information on enrollment for children’s health care coverage, visit:
- CHIP 1-800-986-KIDS (5437) or online
- Medicaid 1-866-550-4355 or online
- Pennie™ 1-844-844-8040 or online
Pennsylvania Partnerships for Children is a strong, effective and trusted voice to improve the health, education and well-being of children and youth in the commonwealth. Since 1992 its public policy victories have helped countless children learn, thrive and succeed, regardless of circumstances. PPC is statewide, independent, non-partisan and non-profit. Learn more at papartnerships.org.
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