Health care reform and its implications for children, nationally and in California

Medicaid and CHIP cover roughly one in three children and more than half of low-income children. While these programs have reached more than 80 percent of eligible children, more than two-thirds of currently uninsured children qualify but are not enrolled. This policy analysis examines how the Patient Protection and Affordable Care Act (ACA) could affect coverage and access for low-income children and their families, both nationally and in California.

ACA offers low-income children three potential gains: their parents will experience a substantial reduction in uninsurance, which will benefit their children in various ways; many uninsured children who already qualify for public programs will enroll; and currently ineligible, uninsured children will gain coverage because of new subsidies and ACA's individual mandate.

Several factors will determine if these gains fully materialize, including: cumbersome Medicaid eligibility methods that can prevent eligible families from enrolling; limited Medicaid provider reimbursement that can reduce access to care; potentially insufficient subsidies in new health insurance exchanges that could make coverage unaffordable for parents; and potential termination of federal CHIP funding after 2015, which could increase costs or reduce benefits for children.

To shape how these factors play out, state policymakers can: use new federal resources to develop information technology that makes eligibility determination more data-driven and family-friendly; improve Medicaid provider participation by expediting claims payment, promoting the adoption of telemedicine, and expanding the scope of practice for mid-level practitioners; and adopt ACA's Basic Health Program option to make coverage more affordable for low-income parents and their children.