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

  • 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.

    You can access data from and information about the current NSCH through the Health Resources and Services Administration’s Maternal and Child Health Bureau, the Data Resource Center for Child & Adolescent Health, or the U.S. Census Bureau.  Data from and information about past NSCH and NS-CSHCN are available through the Data Resource Center for Child & Adolescent Health or the CDC’s National Center for Health Statistics

  • 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