Adequate Insurance Coverage for Children and Adolescents
The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 15 is the percent of children 0 through age 17 who are adequately insured. This evidence brief points to a selection of resources for state MCH programs about insurance coverage for children and adolescents, with emphasis on evidence-based information.
The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
Almost one-quarter of American children with continuous insurance coverage are not adequately insured. Inadequately insured children are more likely to have delayed or forgone care, lack a medical home, be less likely to receive needed referrals and care coordination, and receive family-centered care. The American Academy of Pediatrics highlighted the importance of this issue with a policy statement. The major problems cited were cost-sharing requirements that are too high, benefit limitations, and inadequate coverage of needed services.
Read More about Performance Measure 15
Performance Measure 15
Percent of children 0 through age 17 who are adequately insured
To increase the number of children who are adequately insured
Numerator: Parent report of children, ages 0 through 17 years, who were reported to be adequately insured, based on 3 criteria: whether their children's insurance covers needed services and providers, and reasonably covers costs. If a parent answered "always" or "usually" to all three dimensions of adequacy, then the child was considered to have adequate insurance coverage. (No out-of-pocket costs were considered to be "always" reasonable.)
Denominator: All children, 0 through ages 17 years
Healthy People 2020 Objectives
Related to Access to Health Services (AHS) Objective 1: Increase the proportion of persons with health insurance
Related to Access to Health Services (AHS) Objective 6: Reduce the proportion of persons who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines
Data Sources and Data Issues
The National Survey of Children's Health (NSCH). States can use data from the 2011-2012 NSCH as a baseline.
Data and Statistics
National Survey of Children's Health (NSCH). Funded by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), this survey provides national and state-level data on the physical and emotional health of American children 0 - 17 years old. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.
Since 2003, the NSCH has provided both national and state-level prevalence estimates for a variety of child health and health care indicators. MCHB also fielded the National Survey of Children with Special Health Care Needs (NS-CSHCN) in 2001, 2005-2006, and 2009-2010. Its purpose was to assess the prevalence and impact of special health care needs among children and their families in the U.S. The 2016 NSCH underwent significant redesign and administration changes and differs greatly from the prior survey cycles. From 2016 onward, the purpose of the NSCH remains the same, but the two individual surveys were combined into a single survey conducted every year.
Catalyst Center. Information on health care coverage and financing for children with special health care needs. Sections of the website focus on covering more kids, closing benefit gaps, paying for additional services, and building capacity.
National Business Group on Health. This national association represents large public- and private-sector employers and focuses on health benefits solutions and policy. It provides information on workplace well-being initiatives, best practices, health of dependents (spouses and children), preventive services, and other public health topics. See the Resources section, Resource Library, and search for materials using the keywords insurance unmet needs.
State Coverage Initiatives. This program provides experience- and evidence-based information and technical assistance to state leaders to help them move health care reform forward at the state level. It is a national program of the Robert Wood Johnson Foundation and is adminstered by AcademyHealth.
Flores G, Lesley B. 2014. Children and US federal policy on health and health care: Seen but not heard. JAMA Pediatrics 2014.1701. [Epub ahead of print] View abstract.
DeFrancis B. 2014. Access to care (MCH Navigator training spotlight). Washington, DC: Health Information Group at Georgetown University. Promising practices and pressing issues to help MCH professionals facilitate greater health care access for all.
Colby MS, Lipson DJ, Turchin SR. 2012. Value for the money spent? Exploring the relationship between expenditures, insurance adequacy, and access to care for publicly insured children. Maternal and Child Health Journal 16(Suppl 1):S51-60. View abstract.
Guevara JP, Moon J, Hines EM, Fremont E, Wong A, Forrest CB, Silber JH, Pati S. 2014. Continuity of public insurance coverage: A systematic review of the literature. Medical Care Research and Review 71(2):115-37. View abstract.
Miller JE, Macon T, Gaboda D, Cantor JC. 2012. Unmet need, cost burden, and communication problems in SCHIP by special health care needs status. Maternal and Child Health Journal 16(4):850-9. View abstract.
Health Insurance and Access to Care for Children and Adolescents knowledge path
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 90.
Adequate Insurance Coverage for Children and Adolescents: Evidence Brief, 1st ed. (November 2014).