CHIP Enrollment Expansion for Children

For this week's Dragon Tree Newsletter, we're looking at numbers, numbers, numbers. More specifically, our focus is on numbers of children enrolled in government-sponsored health insurance plans in the U.S.

Here at Dragon Tree, our mission is to support organizations that help people thrive. And there's no one more in need of support these days than children. Data can offer a window into how comprehensively children are covered by health insurance in the U.S., and show us how those totals are likely to trend in the near future.

If you want to dig into the data with us, check out a more expanded version of this post here (the second installment is coming soon). But if you're more interested in a high-level overview, keep reading! 

First, some quick facts:

• According to a recent article in JAMA, "Children who have consistent coverage are more likely to attend well-child visits, have a usual source of care, and (are) less likely to delay or forgo necessary medical care." (Addition is mine.)
• The article further states that, "The health benefits of child insurance coverage have been shown to persist into adulthood, including lower rates of hospitalization, chronic conditions, and obesity."

• According to a recent report by the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, "In Q1 2024, 42.4 percent of children had public coverage and 54.2 percent had private coverage."

• Also of note in that same report, between "Q2 2023 and Q1 2024…(t)he percentage of children with public coverage declined by 2.7 percentage points…"

By "public coverage," the report is referring to government-sponsored healthcare insurance. We'll get into a little more detail on specifics related to this type of insurance, but suffice it to say that in the case of children and other special cases, Medicaid comes into play.

Against this backdrop of declining public insurance coverage for children in the U.S., several states have begun widening eligibility criteria for Medicaid. 

The Children's Health Insurance Program

To help us gain insight into how expanded enrollment is going, we'll highlight numbers in four states: in this newsletter we've focused on Arizona and Maine, and in a subsequent installment we'll hone in on North Dakota and Kansas.

We've chosen these states because they represent the U.S. political spectrum: one of these states is reliably liberal (Maine), one is a swing state (Arizona), and two are reliably conservative states (North Dakota and Kansas). This should give us a good sense of the varieties of expansion on offer as they relate to children, and to what degree they're proving successful.

It's important to note that we've confined our inquiries to enrollment in the Children's Health Insurance Program (CHIP). CHIP is an adjunct to Medicaid that provides "low-cost health coverage to children in families that earn too much money to qualify for Medicaid."

In all of the states we're zooming in on (with the exception of Kansas), the expansions have only recently taken effect. Kansas is a special case, since expanding CHIP eligibility to cover more children has been the subject of debate there for some time now, but hasn't yet passed. Since signs point to Medicaid expansion passing in Kansas soon, we'll add it to the list.  

CHIP Enrollment in Arizona

Let's start with Arizona.

As part of the state budget approval process in 2023, Governor Katie Hobbs and the state legislature agreed on an expansion of KidsCare, which is the name of Arizona's CHIP program. The decision, which enjoyed bipartisan support, allowed KidsCare to expand eligibility to cover more children by increasing family income limits.

According to the KidsCare website, "To qualify for KidsCare, annual family income limits are rising to 225% of the federal poverty level, or an annual household income of up to $70,200 for a family of four."

Since the expansion took effect on March 1, 2024, we thought it would be interesting to look at the first few months of data.

Up first is a graph tracking enrollment rates between May and July of 2024 (Note: as of this writing, data was only updated through July of 2024.)

Curiously, unlike other states on the list, there isn't much data for CHIP enrollment numbers in Arizona prior to May of 2024. As stated above, since access expansion only began in March of this year in Arizona, there isn't much data available. As a consequence, this graph can't tell us much of anything aside from the fact that CHIP enrollment numbers have fallen slightly since families started enrolling their children under the expansion. Again, we'll keep an eye on these numbers to see what happens over time.

CHIP Enrollment in Maine

Now on to Maine. It's important to note that while the CHIP expansion has already been approved, it didn't take effect until August of 2024; consequently, since our data source only has updated numbers through July of 2024, we won't see the expansion reflected in the figures just yet.

But that's OK! We can at least visualize the starting point, and then see if it moves over time.

For now, let's familiarize ourselves with the particulars of Maine's expansion. According to the State of Maine Health and Human Services website, the following is true relative to the eligibility standards for children under the age of 21 in Maine's CHIP program:

"Part 5, Section 6, Income Standard increases the household income for all children from 208% of the Federal Poverty Level (FPL) to 300% of the FPL effective retroactive to October 1, 2023."

So a few things are going on here that are different from Arizona, namely that household income requirements are a bit more generous (300% of the Federal Poverty Level in Maine, compared to 225% in Arizona), and enrollment is retroactive to an earlier date than Arizona's eligibility date.

That being the case, here is a chart looking at CHIP enrollment rates going back a bit further in time, to January of 2023:

We expanded our time frame here because we think it's important to show that CHIP enrollment has been trending upward in Maine over the past year, with the exception of a dip in the summer and fall of 2023. This will provide important context as we watch these rates over time.

That's it for now! In an upcoming newsletter installment we'll examine CHIP expansion in the more conservative states on our list, North Dakota and Kansas.

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