Children on Medicaid and CHIP Have More Affordable Care than Private

Medicaid and CHIP children with special needs have access to care comparable to those on private insurance. Their care is more affordable, though their families experience other hardships.

Children covered by Medicaid or the Children’s Health Insurance Program (CHIP) have greater healthcare needs than those on private insurance, but they have comparable access to care and that care often is more affordable.

Those are findings from a recent analysis by the Henry J. Kaiser Family Foundation, which also found that the families of these children experience additional stress beyond the cost of healthcare. The families are more likely to have to limit their work hours or stop working as a result of their health and more likely to devote time providing or coordinating their healthcare, the Kaiser report says.

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Medicaid is the only source of coverage for many children with special healthcare needs in low and middle income families, but it also fills gaps in private insurance, Kaiser reports. Forty-eight percent of all children with special healthcare needs, about 6.8 million, are covered by Medicaid and CHIP.

“Medicaid/CHIP children with special health care needs experience significantly better access to care on these measures compared with those who are uninsured,” the report says. “Proposals to cap and reduce federal Medicaid funding may pose a particular risk to children with special health care needs because these children use services more intensively, and often incur greater costs, compared to other children.”

These are some other key findings about Medicaid/CHIP children from the report:

• They are significantly more likely to live in low income families compared to those with private insurance only. Seventy-eight percent of Medicaid/CHIP-only children with special health care needs, and 57% of those with both Medicaid/CHIP and private insurance, live in families with incomes below 200% of the federal poverty level, compared to less than 17% of those with private insurance only.
   
• The children are significantly more likely to have multiple health conditions and to be in poorer health compared to those with private insurance alone, with children with both Medicaid/CHIP and private insurance having the greatest needs. “For example, children with special health care needs with both Medicaid/CHIP and private insurance are more than twice as likely (55%), and those with Medicaid/CHIP only are nearly twice as likely (43%), to have four or more functional difficulties compared to those with private insurance alone (24%),” the report says.
   
• They are more likely to report that their coverage is affordable compared to those with private insurance alone.  “For example, those with Medicaid/CHIP only are more than four times as likely (82%), and those with both Medicaid/CHIP and private insurance are more than twice as likely (43%), to report that their out-of-pocket health care costs are always reasonable compared to those with private insurance alone (19%),” the report says. “Over half (53%) families of Medicaid/CHIP-only children with special health care needs, and over a third (36%) of those with both Medicaid/CHIP and private insurance, find it somewhat or very often hard to cover basic needs like housing or food since their child’s birth compared to a fifth (20%) of those with private insurance only.”