Number of Uninsured Children Declined by 210K During Pandemic

The number of uninsured children declined during the COVID-19 pandemic due to Medicaid’s continuous coverage requirement, with 12 states seeing significant decreases, according to a report from the Georgetown University Center for Children and Families.

The report reflects data from the US Census Bureau’s American Community Survey (ACS).

Before the pandemic hit, the uninsurance rate among children was rising, and job losses during the first few months of the pandemic generated concerns that this trend would continue. However, federal policies that helped individuals retain Medicaid coverage and expanded marketplace premium subsidies caused the uninsurance rate to decline.

From 2019 to 2021, the number of uninsured children fell from 4.375 million to 4.165 million, signifying a 5 percent decline. The rate of uninsured children nationally decreased from 5.7 percent to 5.4 percent.

The uninsurance rate among children also changed at the state level during the pandemic, researchers found. Twelve states saw significant improvements in the number or rate of uninsured children.

The most significant coverage gain was in Texas, where 65,000 additional children were insured. However, Texas continued to have the largest number of uninsured children in the country at 930,000, the report noted.

The number of uninsured children decreased by 25,000 in Illinois, 21,000 in Georgia, and 19,000 in Indiana.

Three states—Idaho, New York, and Maryland—saw an increase in the number of uninsured children. The uninsured child population grew by 46 percent in Idaho, signifying the steepest increase.

Regarding uninsurance rates, Oklahoma saw the greatest improvement, with the rate falling from 8.6 percent to 7.4 percent, but the state still ranks 44th in the country. The 1.2 percentage point decline may be attributed to Medicaid expansion. Oklahoma passed a ballot initiative to expand Medicaid under the Affordable Care Act (ACA), which went into effect in June 2021.

The uninsurance rate declined by 1.1 percentage points in both Indiana and Connecticut, going from 7.1 percent to 6.0 percent and 3.5 percent to 2.4 percent, respectively.

States in New England had the lowest uninsurance rates for children in 2021, with Massachusetts having the lowest rate of 1.3 percent and Vermont following at 1.9 percent. Meanwhile, Texas had the highest rate of 11.8 percent. Other southern states also had high rates, including Florida (7.3 percent) and Georgia (6.6 percent).

The Mountain West region, except for Colorado, consistently had uninsurance rates above the national average of 5.4 percent, the report noted.

The uninsurance rate varied among children of different races and those from families with different income levels. For example, American Indian and Alaska Native children saw the most significant decrease in the uninsurance rate, declining by two percentage points between 2019 and 2021.

White children and Asian, Native Hawaiian, and Pacific Islander children saw declines in uninsurance, but the uninsured rate for Black children and children of another race or multiple races rose in 2021.

The uninsured rate for Hispanic/Latino children fell from 9.2 percent to 8.6 percent, while the rate among non-Hispanic/Latino children declined from 4.5 percent to 4.2 percent.

Children from low-income families were more likely to gain insurance coverage in 2021. For example, the uninsurance rate for children in families earning between 138 percent and under 250 percent of the Census poverty threshold went from 7.7 percent to 7.0 percent.

The rate decreased from 7.7 percent to 7.4 for children from families with the lowest income and fell from 3.8 percent to 3.7 percent for those from families with higher incomes.

Although coverage increased for children during the pandemic, the end of the public health emergency (PHE) could reverse these gains. When the PHE expires, Medicaid’s continuous coverage policy will also end, meaning around 6.7 million children could become uninsured.

Among the millions of children at risk of losing Medicaid coverage, around three in four will still be eligible. However, administrative barriers and gaps in the Medicaid system may make it harder for states to process redeterminations and facilitate re-enrollment for eligible beneficiaries.