Health Affairs, 23, no. 5 (2004): 39-50 doi: 10.1377/hlthaff.23.5.39 © 2004 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

This Article Abstract Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Selden, T. M. Articles by Banthin, J. S. Search for Related Content PubMed PubMed Citation Articles by Selden, T. M. Articles by Banthin, J. S. Related Collections Access To Care Health Reform Insurance Coverage - Children Maternal And Child Health Medicaid

Children's Coverage

Tracking Changes In Eligibility And Coverage Among Children, 1996–2002

Abstract

 
Data from the 1996 Medical Expenditure Panel Survey (MEPS) reveal that 4.7 million children were eligible for Medicaid but were uninsured. Numerous changes have occurred in the landscape for children’s health insurance since then, including welfare reform and implementation of the State Children’s Health Insurance Program (SCHIP). We use data from the 1996–2002 MEPS to track changes in the eligibility and coverage of children. As of 2002, uninsurance among children remained as much a problem of participation as one of eligibility. Nevertheless, we find evidence of dramatic improvements in program participation, reflecting the success of efforts to improve outreach, simplify enrollment, and increase retention.

The pace of reform intensified in the late 1990s. Poverty-related Medicaid eligibility continued to expand, and in 1998 states began implementing the State Children’s Health Insurance Program (SCHIP). By 2002, uninsurance among low-income children fell to 18.6 percent.³ Medicaid covered 21.7 million children at some point during 2000, and SCHIP enrollment during the first quarter of 2002 grew to 3.8 million children.⁴

Although expansions in eligibility increased public coverage for children and helped reverse the rise in uninsurance, not all eligible children enroll in public coverage. Research using the 1996 Medical Expenditure Panel Survey (MEPS) found that 4.7 million children were eligible for Medicaid but were uninsured.⁵ Approximately 40 percent of all uninsured children were eligible for public coverage in 1996, making uninsurance among children as much a problem of enrollment as one of eligibility.⁶

Since 1996 the economy has expanded and contracted, and private insurance premiums have outpaced the general rate of inflation. Both changes may have influenced trends in private and public coverage. Moreover, there have been several major changes in public policy. Welfare reform restricted immigrants’ eligibility for public coverage and may have deterred some eligible immigrant families from enrolling.⁷ Welfare reform also restricted eligibility for cash payments and severed the link between cash welfare and Medicaid. One consequence of this may have been reduced Medicaid enrollment, if fewer families applied for welfare or if applicants were not informed of their Medicaid eligibility.⁸

Concerns about Medicaid enrollment also led to concerns about enrollment in SCHIP.⁹ Many children made eligible through the Medicaid expansions had failed to enroll, and in the absence of substantial outreach efforts, SCHIP enrollment rates seemed likely to be lower still. One reason for this is that enrollment rates decline with age, and SCHIP-eligible children are older on average than Medicaid-eligible children. Also, SCHIP-eligible children typically have working parents who may be unaccustomed to applying for public benefits.

Concerns about Medicaid and SCHIP enrollment have led to unprecedented efforts to improve outreach, reduce stigma, simplify enrollment, and retain eligible enrollees since 1996.¹⁰ SCHIP may also have had a beneficial spillover effect on Medicaid enrollment, because its legislation requires states to screen SCHIP applicants for Medicaid eligibility.¹¹ Finally, expansions in family coverage under Medicaid may have increased enrollment among children.¹²

Given the many changes since 1996, it is useful to examine recent trends in eligibility and coverage among children. We rely on data from the 1996, 1998, 2000, and 2002 MEPS, combining a consistent data source with a consistent eligibility simulation methodology over time to estimate trends.

Data And Methods

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 
The data for our analysis come from MEPS, a stratified and clustered random sample of households sponsored by the Agency for Healthcare Research and Quality (AHRQ).¹³ When combined with sample weights, MEPS is designed to yield nationally representative estimates of insurance coverage, medical expenditures, and a wide range of other health-related and socioeconomic characteristics for the civilian, noninstitutionalized population. MEPS has an overlapping panel design, with data collected in five rounds over two and a half years. We focus on eligibility and enrollment of children age eighteen and under in the first part of each calendar year. The number of sampled children varies from a low of 7,446 in 1996 to a high of 13,050 in 2002, for a total of 36,729 observations. All results discussed in the text are statistically significant at the 5 percent level unless otherwise noted. All standard errors and statistical tests are adjusted for the complex design of MEPS.

Insurance coverage definitions. We considered children to be covered if they had insurance covering physician and hospital care at any time during the round (typically four to five months). Thus, we classified children as uninsured only if they were continuously without coverage during the entire round. The 1–2 percent of all children who held both public and private coverage were classified as having public coverage.

Income measurement. We measured earnings from all jobs held during the interview week. Our earnings measure thereby corresponds as closely as possible to the period during which we measured insurance coverage. To measure unearned income from interest, dividends, Social Security, and pensions, we linked MEPS data to the National Health Interview Survey (NHIS). This survey provides us with indicators for income receipt by type, which we used in constructing cold-deck imputations from MEPS full-year data.¹⁴ We obtained our estimate of assets by capitalizing interest and dividend income flows using the average return on six-month certificates of deposit.¹⁵

Eligibility simulation. Our eligibility simulation refines the approach previously used with the 1996 MEPS.¹⁶ We used data on age, earned and unearned income, marital status, employment status, family structure, and state of residence, combined with detailed program eligibility rules by state and by year.¹⁷ In particular, we applied detailed rules regarding income disregards, assistance unit composition, and asset tests.

We also simulated eligibility according to immigration status. Legal immigrant children often face more stringent eligibility criteria than citizen children, and undocumented aliens are rarely eligible for public coverage. Linked NHIS data provide information on nativity, length of time in the United States, and citizenship.¹⁸ Among children in families under 200 percent of the federal poverty level in 2002, 4.4 percent of all children and 10.0 percent of uninsured children were ineligible for Medicaid and SCHIP solely based on their immigration status.¹⁹

We grouped children into three broad classes of eligibility. "Welfare-related" Medicaid eligibles include children in families eligible for welfare or (after welfare reform) Section 1931 family coverage. This group also includes children eligible through medically needy programs, the Ribicoff Children program, free Medicaid waiver programs targeting families, and separate state-funded programs providing similar coverage to immigrant families.

"Poverty-related" Medicaid eligibles include children born after 30 September 1983 into families with net incomes below the federal poverty guidelines, children under age six in families below 133 percent of poverty, and those eligible through state expansions covering older children and those in families with higher incomes. This category also includes remaining children eligible for free coverage through Medicaid waivers and through separate state-funded programs to provide similar coverage to immigrant children.

Finally, "SCHIP" includes children eligible for Medicaid SCHIP, separate state SCHIP, or separate state-funded programs to provide similar coverage to immigrant children. Also, some states expanded coverage before SCHIP implementation, providing SCHIP-like coverage to children later targeted by SCHIP. We therefore included in this group children eligible for public coverage via other non-SCHIP state programs or Medicaid waivers requiring (subsidized) premiums.

Study Results

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 
Insurance coverage by poverty status. As of 2002, 61 percent of all children held private coverage, 26 percent held public coverage, and 13 percent were uninsured (Exhibit 1). Among poor children (below 100 percent of poverty), the dominant form of coverage was public insurance. Among near-poor children (100–200 percent of poverty), private and public coverage played approximately equal roles. For middle- and higher-income children (above 200 percent of poverty), private insurance was the dominant form of coverage.

Private coverage among all children rose and fell between 1996 and 2002, mirroring the economic expansion and contraction over the period.²⁰ By 2002, private coverage rates were slightly below 1996 levels (not a significant difference). In contrast, the percentage of children with public coverage rose five percentage points from 1997 to 2002, and the percentage without coverage fell steadily.

The largest increase in public coverage was among near-poor children. This twelve-percentage-point increase reflects declines in both uninsurance and private coverage.²¹ In particular, private coverage among near-poor children declined by 7.9 percentage points between 1996 and 2002. This may reflect "crowd-out," whereby families dropped private coverage for their children when free or highly subsidized public coverage became available. Researchers have found evidence of this phenomenon in both the Medicaid and SCHIP expansions.²² Declines in private coverage may also reflect premium increases. Clearly, the trends we present here are not sufficient to identify separately these two effects on private coverage.

Eligibility for public coverage. The number of children eligible for free or highly subsidized public coverage expanded from 21.4 million in 1996 to 36.0 million in 2002 (Exhibit 2). The proportion of all children eligible for such coverage rose from 28.6 percent in 1996 to 47.1 percent in 2002. This is almost entirely attributable to the introduction of SCHIP in 1998 and its subsequent expansions. By 2002, 19.6 percent of all children were eligible for SCHIP based on income and assets, and 8.8 percent also met SCHIP’s requirement that they not be enrolled in private coverage.

Third, SCHIP take-up rates rose throughout SCHIP’s implementation. As expected, take-up rates were initially quite low. As of 2000, predictions that SCHIP take-up would be under 50 percent absent major improvements in outreach were largely correct.²⁴ However, SCHIP take-up continued to rise, and by 2002 it had reached 60.4 percent.

As a final step, we used multivariate analysis to examine whether the trends in Exhibit 4 might simply be attributable to changes in the mix of eligible children over time. We used a probit model for enrollment in public coverage, restricting the sample to children enrolled in public coverage or uninsured. This enabled us to examine take-up rates over time, while controlling for a wide range of socioeconomic factors that might affect eligibility or enrollment.²⁵ Within welfare-related Medicaid, the adjusted increase in take-up between 1996 and 2002 was 3.2 percentage points (not statistically significant); it was 18.9 percentage points among expansion-related eligibles. Within SCHIP, the adjusted increase in take-up between 1998 and 2002 was 21.7 percentage points. Because our adjusted results mirror the unadjusted trends presented in Exhibit 4, we conclude that the trends in Exhibit 4 represent real increases in take-up rates that are not merely the result of changes in the mix of eligible children over time.

Limitations And Comparisons With Other Studies

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 
Limitations. Our study has three notable limitations. First, although we are careful to account for rules governing family composition, income net of disregards, assets, and immigration status, all of these variables may be measured with error in our data. Also, we do not simulate transitional or continuation eligibility, disability-related eligibility, or presumptive eligibility. For this reason, we may underestimate the number of eligible children, the number of eligible but uninsured children, and take-up rates.

Second, we deem children to be uninsured only if they continuously lacked coverage during the round (typically four to five months). By ignoring shorter spells of uninsurance, our results may understate the true extent to which eligible children lack coverage. Third, an issue with all household surveys is the accuracy of coverage data. Comparisons with administrative data suggest that MEPS may modestly undercount enrollment in public coverage. Nevertheless, MEPS is widely regarded as providing more accurate and consistent public coverage estimates than the Current Population Survey (CPS), perhaps because MEPS asks numerous detailed questions regarding the presence, source, and duration of coverage.²⁶ Also noteworthy is that MEPS and the CPS find higher levels of uninsurance than either the National Survey of America’s Families (NSAF) or the NHIS. Indeed, this difference has grown since the late 1990s, with NSAF and the NHIS showing faster declines in uninsurance and faster increases in public coverage than either MEPS or the CPS.²⁷

Comparison of results. Given the potential for differences across surveys and eligibility simulations, it is useful to compare our results with other published estimates. Our estimates of uninsured eligible children in 2000 are close to those from the 1999 NSAF. We estimate that 6.4 million eligible children were uninsured throughout the round (4.0 million were eligible for Medicaid and 2.4 million for SCHIP). The 1999 NSAF estimate is that 6.8 million eligible children were uninsured as of the interview date (4.6 million were eligible for Medicaid and 2.2 million for SCHIP).²⁸ Similarly, our public coverage take-up rate for 2000 is 68.8 percent, which is close to the 68 percent take-up rate from the 1999 NSAF.²⁹ Our 2002 MEPS estimates are also close to a CPS-based study that found that 6.5 million children were eligible for Medicaid or SCHIP but were uninsured in 2002.³⁰ In contrast, adjusting CPS data in an effort to correct for undercounted public coverage yields an estimate that fewer than five million children in 2000 were eligible for Medicaid or SCHIP but were uninsured.³¹ Clearly, no survey or eligibility simulation is free from potential errors, and estimates from any one survey or eligibility simulation should be interpreted with caution.

Discussion

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 
Between 1996 and 2002 the proportion of all children who were eligible for free or heavily subsidized public health insurance coverage rose from 28.6 percent to 47.1 percent. Not surprisingly, the number of eligible uninsured children rose as well, from 4.6 million in 1996 to 6.2 million in 2002. As of 2002, more than 60 percent of all uninsured children were eligible for public coverage. What was true in 1996 was even more true in 2002: Participation remains a key problem among uninsured children.

Children’s enrollment in public coverage remains far from complete, yet dramatic progress has been made. First, we observe no net decline in take-up among welfare-related eligible children. Early studies found evidence of declines in Medicaid participation in the wake of immigration and welfare reform.³² Our results for 1996 to 1998 mirror those findings. However, if immigration and welfare reforms had the hypothesized negative effect on take-up, by 2002 those effects were offset by state efforts to improve outreach, simplify enrollment, and increase retention.

Second, we find large increases in take-up among Medicaid expansion–eligible children, from the low levels observed in 1996 to levels in 2002 that were close to those for welfare-related eligibles.³³ Third, we observe remarkable increases in take-up among SCHIP-eligible children. These findings are confirmed by our multivariate analysis, in which we controlled for a wide range of socioeconomic characteristics of children and their families.

We interpret our results as evidence of the effects of improved outreach, reduced stigma, enrollment simplification, continuous coverage, and the myriad other improvements in Medicaid and SCHIP implemented since the mid-1990s.³⁴ In many states, reform efforts focused on SCHIP, but we observe equally large improvements in the take-up rates of both Medicaid and SCHIP. This suggests that these programs may have important spillover effects on each other.

It may be overly optimistic to anticipate continued improvements in take-up rates beyond the period of our study. Recently, states have faced intense fiscal pressures. These pressures, combined with rapidly rising enrollment in public coverage, have led many states to begin rolling back SCHIP eligibility or the outreach programs and simplifications that are likely to have increased take-up rates.³⁵ Whether these gains can be preserved in the present fiscal climate is an important open question that we hope will be answered by future waves of MEPS.

Editor's Notes

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 
Thomas Selden (tselden{at}ahrq.gov) and Julie Hudson are economists, and Jessica Banthin is director, Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, at the Agency for Healthcare Research and Quality in Rockville, Maryland.

The authors are grateful for the helpful suggestions of Cindy Brach, Randolph Capps, Lisa Dubay, Trena Ezzati-Rice, Sarah Grantham, Carol Irvin, Genevieve Kenney, Julie Martinez, John Moeller, and John Sommers, along with the expert programming assistance of Devi Katikineni and Jackie Malone of Social and Scientific Systems. They also thank Leighton Ku, Randolph Capps, Jeffrey Passel, Kenneth Sucher, and Carol Irvin for generously sharing data. Any remaining errors are the authors’ own. The views expressed in this paper are those of the authors, and no official endorsement by the Department of Health and Human Services or the Agency for Healthcare Research and Quality is intended or should be inferred.

NOTES

Top Data And Methods Study Results Limitations And Comparisons With... Discussion Editor's Notes NOTES

 

1. R.M. Weinick and A.C. Monheit, "Children’s Health Insurance Coverage and Family Structure, 1977–1996," Medical Care Research and Review 56, no. 1 (1999): 55–73. Estimate is for children age seventeen and under with family income below 200 percent of poverty and at least one parent or stepparent.[Abstract/Free Full Text]
2. Ibid. See also J.S. Banthin and T.M. Selden, "The ABCs of Children’s Health Care: How the Medicaid Expansions Affected Access, Burden, and Coverage between 1987 and 1996," Inquiry 40, no. 2 (2003): 133–145.[Web of Science][Medline]
3. Authors’ calculations (standard error = 1.0). Estimate is for children age seventeen and under with family income under 200 percent of poverty and at least one parent or stepparent.
4. Centers for Medicare and Medicaid Services, "Medicaid Eligibles—Fiscal Year 2000 by Age Group: All States," April 2004, www.cms.hhs.gov/medicaid/msis/00total.pdf (30 April 2004); and "The State Children’s Health Insurance Program Quarterly Enrollment Report," July 2002, www.cms.hhs.gov/schip/enrollment/fy02sqer.pdf (30 April 2004).
5. T.M. Selden, J.S. Banthin, and J.W. Cohen, "Medicaid’s Problem Children: Eligible but Not Enrolled," Health Affairs 17, no. 3 (1998): 192–200.[CrossRef][Medline]
6. Ibid. See also D.M. Cutler and J. Gruber, "Does Public Insurance Crowd Out Private Insurance?" Quarterly Journal of Economics 111, no. 2 (1996): 391–430[CrossRef][Web of Science]; L.C. Dubay, J. Haley, and G.M. Kenney, Children’s Eligibility for Medicaid and SCHIP: A View from 2000, Assessing the New Federalism Series B, Number B-41 (Washington: Urban Institute, 2002); and M. Broaddus and L. Ku, Nearly 95 Percent of Low-Income Uninsured Children Now Are Eligible for Medicaid or SCHIP (Washington: Center on Budget and Policy Priorities, 2000).
7. M. Fix and J. Passel, "The Scope and Impact of Welfare Reform’s Immigration Provisions," Assessing the New Federalism Discussion Paper no. 02-03 (Washington: Urban Institute, 2002).
8. L. Ku and B. Garrett, "How Welfare Reform and Economic Factors Affected Medicaid Participation: 1984–96," Assessing the New Federalism Discussion Paper no. 00-01 (Washington: Urban Institute, 2000); K. Kronebusch, "Medicaid for Children: Federal Mandates, Welfare Reform, and Policy Backsliding," Health Affairs 20, no. 1 (2001): 97–111[Abstract/Free Full Text]; and R. Kaestner and N. Kaushal, "The Effect of Welfare Reform on Health Insurance Coverage of Low-Income Women and Children," Journal of Health Economics 22, no. 6 (2003): 959–983.[CrossRef][Web of Science][Medline]
9. T.M. Selden, J.S. Banthin, and J.W. Cohen, "Waiting in the Wings: Eligibility and Enrollment in the State Children’s Health Insurance Program," Health Affairs 18, no. 2 (1999): 126–133.[CrossRef][Medline]
10. D.C. Ross and L. Cox, Enrolling Children and Families in Health Coverage: The Promise of Doing More (Washington: Kaiser Commission on Medicaid and the Uninsured, 2002); National Governors Association, MCH Update 2002: State Health Coverage for Low-Income Pregnant Women, Children, and Parents (Washington: NGA, 2003); A.W. Dick et al., "Consequences of States’ Policies for SCHIP Disenrollment," Health Care Financing Review 23, no. 3 (2002): 65–88[Medline]; I. Hill and A.W. Lutzky, Is There a Hole in the Bucket? Understanding SCHIP Retention (Washington: Urban Institute, 2003); and Lake, Snell, and Perry Associates, Retaining Eligible Children and Families in Medicaid and SCHIP: What We Know So Far: A Review of Research Prepared for Covering Kids and Families (Columbia, S.C.: Covering Kids and Families, 2003).
11. CMS, The State Children’s Health Insurance Program Annual Enrollment Report: Federal Fiscal Year 2001, January 2002, www.cms.hhs.gov/schip/enrollment/schip01.pdf (30 April 2004).
12. Selden et al., "Waiting in the Wings."
13. J.W. Cohen et al., "The Medical Expenditure Panel Survey: A National Health Information Resource," Inquiry 33, no. 4 (1996): 373–389; and S.B. Cohen, Sample Design of the 1996 Medical Expenditure Panel Survey Household Component, MEPS Methodology Report no. 2, Pub. no. 97-0027 (Rockville, Md.: AHRQ, 1997).
14. Although MEPS also collects data on unearned income, they are collected in later rounds and are unavailable until nearly two years after the data we use become available.
15. U.S. Census Bureau, Statistical Abstract of the United States: 2002 (Washington: U.S. Government Printing Office, 2003), Table 1168.
16. Selden et al., "Medicaid’s Problem Children."
17. Sources for program rules include the Urban Institute’s Welfare Rules Database, www.urban.org/Content/Research/NewFederalism/AboutANF/AboutANF.htm (12 July 2004); L. Ku, F. Ullman, and R. Almeida, "What Counts? Determining Medicaid and CHIP Eligibility for Children," Assessing the New Federalism Discussion Paper no. 99-05 (Washington: Urban Institute, 1999) and the associated database; D.C. Ross and L. Cox, Making It Simple: Medicaid for Children and CHIP Income Eligibility Guidelines and Enrollment Procedures: Individual State Profiles, Pub. no. 2191 (Washington: Kaiser Commission on Medicaid and the Uninsured, 2000); National Governors’ Association, MCH Update 2002 (Washington: NGA, 2002 and earlier years); M. Broaddus et al., Expanding Family Coverage: States’ Medicaid Policies for Working Families in the Year 2000 (Washington: Center on Budget and Policy Priorities, 2002); as well as information from state Web pages, CMS documents, and discussions with state program administrators.
18. Missing values were edited using hot-deck imputations. Prior to our 2000 data, the NHIS does not report citizenship for foreign-born residents, so we imputed citizenship based on nativity, arrival date, race/ethnicity, MEPS interview language, poverty level, age, family structure, education, and region. Although we did not observe the legal status of noncitizens, we adjusted our estimates using legal status probabilities, following Dubay et al., "Children’s Eligibility for Medicaid and SCHIP." Legal status probabilities by age, poverty level, ethnicity, arrival date, marital status, education, region, and urbanicity were generously provided by Randolph Capps, Jeffrey Passel, and Kenneth Sucher (all of the Urban Institute). See also J.S. Passel and R.L. Clark, Immigrants in New York: Their Legal Status, Incomes, and Taxes (Washington: Urban Institute, 1998). For more on immigration status and program eligibility, see Zimmermann and Tumlin, Patchwork Policies; Fix and Passel, The Scope and Impact of Welfare Reform’s Immigration Provisions; R. Capps, L. Ku, and M. Fix, How Are Immigrants Faring after Welfare Reform? Preliminary Evidence from Los Angeles and New York City (Washington: Urban Institute, 2002); and C. Schlosberg, Immigrant Access to Health Benefits: A Resource Manual (Boston: Access Project, 2002).
19. Authors’ calculations (standard errors are 0.4 and 1.2, respectively). MEPS estimates trend upward from 1996 immigration impacts of 1.9 percent (s.e. = 0.3) and 3.3 percent (s.e. = 0.6), respectively. Corresponding estimates from Dubay et al., "Children’s Eligibility for Medicaid and SCHIP," for 1999 are 2.3 percent and 8.0 percent.
20. Private coverage rates in 1996 were significantly below levels in 1998 and 2000 (jointly) at the 10 percent level. The joint test of private coverage rates in 1998 and 2000 versus 2002 is statistically significant at the 1 percent level.
21. The decline for near-poor children is significant only at the 10 percent level.
22. For Medicaid, see Cutler and Gruber, "Does Public Insurance Crowd Out Private Insurance?"; and L.C. Dubay and G.M. Kenney, "The Effects of Medicaid Expansions on Insurance Coverage of Children," Future of Children 6, no. 1 (1996): 152–161. [CrossRef][Web of Science][Medline]For SCHIP, see A. LoSasso and T. Buchmueller, "The Effect of the State Children’s Health Insurance Program on Health Insurance Coverage," NBER Working Paper no. 9405 (Cambridge, Mass.: National Bureau of Economic Research, 2002); and T. Buchmueller et al., "The Effect of SCHIP Expansions on Health Insurance Decisions by Employers" (Presentation at the Twenty-fifth Annual Research Conference, Association for Public Policy and Management, Washington, D.C., 7 November 2003).
23. Our 1996 estimate is slightly below the estimate of 4.7 million eligible uninsured children in Selden et al., "Medicaid’s Problem Children," because of refinements in our eligibility simulation. Corresponding estimates for eligible uninsured children age seventeen and under are 4.3 million in 1996 (s.e. = 0.4) and 5.7 million in 2002 (s.e. = 0.3).
24. Selden et al., "Waiting in the Wings."
25. We include age, sex, race/ethnicity, immigration status, self-reported health status, family income relative to the poverty level, family structure, family educational attainment, region, and urbanicity. We estimate separate models for each broad eligibility category.
26. A. Winter and M.E. Moyer, Understanding Estimates of Uninsured Children: Putting the Differences in Context, ASPE Research Note (Washington: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 1999).
27. U.S. Census Bureau, "Table HI-2, Health Insurance Coverage Status and Type of Coverage—All Persons by Age and Sex: 1987 to 2002," April 2004, www.census.gov/hhes/hlthins/historic/hihistt2.html (4 June 2004); G. Kenney, J. Haley, and A. Tebay, Children’s Insurance Coverage and Service Use Improve, Snapshots of American Families III, no. 1 (Columbia, S.C.: Covering Kids and Families, 2003); and National Center for Health Statistics, "Appendix Table 1, Number and Percent of Persons Uninsured, with Public or Private Coverage, Based on the 1990 and 2000 Census Population Estimates, by Age Group: United States, 2000–2002," December 2003, www.cdc.gov/nchs/data/nhis/earlyrelease/200312_app.pdf (7 June 2004).
28. Dubay et al., Children’s Eligibility for Medicaid and SCHIP. See also Broaddus and Ku, Nearly 95 Percent of Low-Income Uninsured Children Now Are Eligible for Medicaid or SCHIP.
29. J. Holahan, L. Dubay, and G. Kenney, "Which Children Are Still Uninsured and Why? The Future of Children" (Los Altos, Calif.: David and Lucile Packard Foundation, forthcoming).
30. American Academy of Pediatrics, "Fact Sheet: Children’s Health Insurance and Medicaid" (Elk Grove Village, Ill.: AAP, 2003).
31. Covering Kids, "New Data: Nearly Five Million Children in America Are Needlessly Uninsured," Press Release, 1 August 2002, www.coveringkidsandfamilies.org/press/releases/index.php?PressReleaseID=5 (7 June 2004).
32. Kronebusch, "Medicaid for Children"; and Kaestner and Kaushal, "The Effect of Welfare Reform on Health Insurance Coverage."
33. Selden et al., "Medicaid’s Problem Children."
34. See also G. Kenney, J. Haley, and A. Tebay, Familiarity with Medicaid and SCHIP Programs Grows and Interest in Enrolling Children Is High, Snapshots of America’s Families III, no. 2 (Washington: Urban Institute, 2003).
35. See, for example, E.M. Howell, I. Hill, and H. Kapustka, SCHIP Dodges the First Budget Ax, New Federalism: Issues and Options for States no. A-56 (Washington: Urban Institute, 2002); D.C. Ross and L. Cox, Preserving Recent Progress on Health Coverage for Children and Families: New Tensions Emerge: A Fifty State Update on Eligibility, Enrollment, Renewal, and Cost-Sharing Practices in Medicaid and SCHIP (Washington: Kaiser Commission on Medicaid and the Uninsured, 2003); and E. O’Brien and C. Mann, Maintaining the Gains: The Importance of Preserving Coverage in Medicaid and SCHIP (Columbia, S.C.: Covering Kids and Families, 2003).

                      What's this?

This article has been cited by other articles:

				M. A. Fisher and A. K. Mascarenhas A Comparison of Medical and Dental Outcomes for Medicaid-Insured and Uninsured Medicaid-eligible Children: A U.S. Population-Based Study J Am Dent Assoc, November 1, 2009; 140(11): 1403 - 1412. [Abstract] [Full Text] [PDF]

				Z. N Cooper, A. McGuire, S Jones, and J L. Grand Equity, waiting times, and NHS reforms: retrospective study BMJ, September 3, 2009; 339(sep03_2): b3264 - b3264. [Abstract] [Full Text] [PDF]

				B. D. Sommers Why Millions Of Children Eligible For Medicaid And SCHIP Are Uninsured: Poor Retention Versus Poor Take-Up Health Aff., September 1, 2007; 26(5): w560 - w567. [Abstract] [Full Text] [PDF]

				A. S. Sommers, L. Dubay, L. J. Blumberg, F. E. Blavin, and J. L. Czajka Dynamics In Medicaid And SCHIP Eligibility Among Children In SCHIP's Early Years: Implications For Reauthorization Health Aff., September 1, 2007; 26(5): w598 - w607. [Abstract] [Full Text] [PDF]

				J. L. Hudson and T. M. Selden Children's Eligibility And Coverage: Recent Trends And A Look Ahead Health Aff., September 1, 2007; 26(5): w618 - w629. [Abstract] [Full Text] [PDF]

				G. Kenney and J. Yee SCHIP At A Crossroads: Experiences To Date And Challenges Ahead Health Aff., March 1, 2007; 26(2): 356 - 369. [Abstract] [Full Text] [PDF]

				M. Jacobson and T. C. Buchmueller Can Private Companies Contribute To Public Programs' Outreach Efforts? Evidence From California Health Aff., March 1, 2007; 26(2): 538 - 548. [Abstract] [Full Text] [PDF]

				T. M. Selden Compliance With Well-Child Visit Recommendations: Evidence From the Medical Expenditure Panel Survey, 2000-2002 Pediatrics, December 1, 2006; 118(6): e1766 - e1778. [Abstract] [Full Text] [PDF]

				J. Fossett and F. J. Thompson Administrative Responsiveness to the Disadvantaged: The Case of Children's Health Insurance J. Public Adm. Res. Theory., July 1, 2006; 16(3): 369 - 392. [Abstract] [Full Text] [PDF]

				B. D. Sommers Protecting Low-Income Children's Access to Care: Are Physician Visits Associated With Reduced Patient Dropout From Medicaid and the Children's Health Insurance Program? Pediatrics, July 1, 2006; 118(1): e36 - e42. [Abstract] [Full Text] [PDF]

				C. R. Gresenz, J. Rogowski, and J. J. Escarce Dimensions of the Local Health Care Environment and Use of Care by Uninsured Children in Rural and Urban Areas Pediatrics, March 1, 2006; 117(3): e509 - e517. [Abstract] [Full Text] [PDF]

				B. D. Sommers The Impact Of Program Structure On Children's Disenrollment From Medicaid And SCHIP Health Aff., November 1, 2005; 24(6): 1611 - 1618. [Abstract] [Full Text] [PDF]

				A. Davidoff, G. Kenney, and L. Dubay Effects of the State Children's Health Insurance Program Expansions on Children With Chronic Health Conditions Pediatrics, July 1, 2005; 116(1): e34 - e42. [Abstract] [Full Text] [PDF]

				M. M. Davis Planning the Next Wave of SCHIP Research Pediatrics, February 1, 2005; 115(2): 492 - 494. [Full Text] [PDF]

				G. Kenney and D. I. Chang The State Children's Health Insurance Program: Successes, Shortcomings, And Challenges Health Aff., September 1, 2004; 23(5): 51 - 62. [Abstract] [Full Text] [PDF]