Adequate and affordable health care coverage is a pressing need for all families and children.  About 15% of the US population (or 43.8 million) lacked health coverage in 2008, including 6.6 million Children (CDC, 2009).  The high cost of health care has necessitated the institution of public health insurance programs to cover certain at-risk populations, including children and those in poverty.  As a federal-state matching entitlement program, public programs – Medicaid and SCHIP – offer health care coverage to lower-income children when employer-based or private health care is not available or affordable.

Recent proposed legislation targeting health care reform at the national level has the potential to greatly alter the landscape of affordable coverage and health insurance policy.  A Health Reform Summit of congressional members is planned for late February 2010.  See the links under National Resources for websites that are tracking congressional bills, news, and current events in the health care reform debate.  See also Health Access and Cultural Competency.

Medicaid & SCHIP

Medicaid (1965) provides insurance coverage to the lowest-income families and children.  The State Children’s Health Insurance Program (CHIP or SCHIP, 1997) is meant to “fill the insurance coverage gap” for lower-income families whose incomes are too high for Medicaid eligibility but too low to afford private health insurance.  SCHIP has greatly reduced the number of uninsured US children.

Medicaid and SCHIP eligibility requirements for children and pregnant women are set by individual states in terms of “percent of the poverty level.”  Eligibility and enrollment data for the St. Louis metro area is as follows:

Eligibility1 MO IL
Age 0-1 185% 200%
Age 1-5 150%
Age 6-19 100%
Age 1-19 133%
Separate CHIP 300% 200%
Pregnant Women 185% 200%
Legal Immigrants Yes, 5-yr. wait Yes, no wait
Foster Children 18+ Yes No
Enrollment 2 US MO IL
Medicaid (all ages) 44.7 million 865,4776 2,098,700
Medicaid (children) 23.5 million 521,8836 1,298,600
SCHIP 3 (children) 7 million3 66,0003 1.5 million5

Early in 2009, Congress passed the Children’s Health Insurance Program Reauthorization Act (CHIPRA), which extends the program until 2013, and increases the number of children who are eligible for the program.

Missouri, MO HealthNet

Though Missouri enrolls 66,000 children in its programs, 150,000 remain uninsured.3 In 2007, Missouri renamed its Medicaid and SCHIP programs; both are now referred to as MO HealthNet for Kids, and the program covers 34% of Missouri’s children.The Medicaid portion of MO HealthNet for Kids covers the neediest children at 100% to 185% the federal poverty level.  The SCHIP portion of MO HealthNet for Kids, formerly called MC+ for Kids, offers coverage for children between the Medicaid eligibility level and 300% of the federal poverty level ($52,800 for a family of 3 in 2008).  This program requires some parents and caregivers to pay monthly premium payments, based on income level.4 Changes as a result of the 2005 legislative session caused over 118,000 people (21,000 children) to lose health care coverage over the following two years.  As of 2009, enrollment numbers had not yet recovered.

Illinois, All Kids

Illinois children eligible for Medicaid or SCHIP are currently served byAll Kids.  1.5 million children are enrolled in the program, which provides coverage regardless of income (premiums may be required), immigration status or health condition.  Medicaid enrollment in the state of Illinois has increased steadily since the mid-1990s.

1Kaiser Family Foundation (December 2009). A Foundation for Health Reform.

2Kaiser Family Foundation. (February, 2010).  Medicaid Enrollment in 50 States: December 2008 Data Update.

3Missouri Foundation for Health. (2009).  Cover Missouri: SCHIP Reauthorization 2009.

4Barker, M.R. (2009). MO Medicaid Basics. Winter 2009.  Retrieved September 14, 2009.

5State of Illinois, AllKids.  (2010).  About All Kids. Retrieved March 11, 2010.

6Missouri Department of Social Services. (2010). DSS Caseload Counter.Retrieved June 21, 2010.  Data from September 2009 (latest available).