A new series of issue briefs conveys recent positive developments, unmet needs, and emerging priorities in health care coverage and delivery for children in low-income families. The briefs provide the perspectives of stakeholders in the diverse states of California, Colorado, and Texas. These states, which have different political landscapes and approaches to coverage of and care for children in low-income families, offer a snapshot of concerns confronting states nationally, including the difficulties families face in navigating Medicaid and Children’s Health Insurance Program (CHIP) coverage and services.
States’ policy and programmatic decisions related to the Affordable Care Act (ACA), which introduced a mix of mandatory and voluntary provisions, provide an interesting glimpse into how state government philosophies can powerfully shape coverage and access to health care for children in low-income families over just a few years. Across the three study states, stakeholders observed the following:
- California’s and Colorado’s decisions to expand Medicaid, along with other state policy decisions, created a welcome-mat effect to help reduce the numbers of uninsured children in low-income families in recent years. Although Medicaid expansion focuses primarily on adults, stakeholders noted that insured adults are more likely than their uninsured peers to enroll their children in coverage.
- Although Texas has not expanded Medicaid under the ACA, it has, like California and Colorado, used ACA funding to introduce some enrollment simplifications and provide more outreach and enrollment assistance to families.
- To varying degrees in all three states, stakeholders report that families cannot easily find providers who accept new Medicaid patients. Poor access to pediatric subspecialty services, especially children’s psychiatric services, is a common concern.
“In all three states, stakeholders said access to health care for children in low-income families may be less than optimal,” reported Leslie Foster, director of Health Research, who oversaw the study. California and Colorado stakeholders describe strong networks of safety net and other providers, but are concerned about their capacity to deliver high quality care to growing numbers of children with Medicaid or CHIP coverage. Access to primary care is challenging in some parts of Texas for uninsured children and those with Medicaid or CHIP because of provider shortages and low Medicaid participation among providers. All three states are short on specialists providing care to low-income children, particularly behavioral health specialists. In addition, access tends to be more problematic in rural areas.
Looking ahead, stakeholders identified several ways to make health systems in California, Colorado, and Texas work better for children in low-income families. Their recommendations included continuing to advocate for or support expanded Medicaid programs and CHIP funding and reauthorization; strengthening targeted outreach to remaining uninsured children, particularly children of immigrants; improving health literacy among families with children in Medicaid or CHIP; and various methods to promote health workforce development and improve networks of primary and specialty care providers serving children in low-income families.
Read more about the study, funded by the David and Lucile Packard Foundation and the Colorado Health Foundation.