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.

Significance

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

Goal

To increase the number of children who are adequately insured

Definition

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

Units: 100

Text: Percent

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

  • Data Resource Center for Child and Adolescent Health. Easy-to-use tools for searching and comparing data from the National Survey of Children's Health and National Survey of Children with Special Health Care Needs. The most recent information on Performance Measure 9 is this chart. To find earlier data, use the Keyword Search box.

    National Survey of Children's Health. This survey examines the physical and emotional health of children ages 0-17. The website provides descriptions of the survey, questionnaires used in the survey, and datasets. It has been conducted in 2003, 2007, and 2011-2012.

    National Survey of Children with Special Health Care Needs. This survey assesses the prevalence and impact of special health care needs among children in the United States and evaluates change over time. It has been conducted in 2001, 2005-2006, and 2009-2010. After 2014 this survey will be combined with the National Survey of Children's Health.
  • Healthy People 2020: Access to Health Services Lists objectives for access to health services, evidence based interventions and resources, and national data that tracks the progress in meeting the objectives.

    Objective AHS-1 refers to increasing the proportion of persons with health insurance.

    Objective AHS-6 refers to persons who are unable to obtain or delay in obtaining necessary medical or dental care or prescriptions medicines.

Key Websites

Policy Recommendations

Interventions

Further Reading

Related NCEMCH Resources

  • 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).

Author: Olivia K. Pickett, M.A., M.L.S., NCEMCH