Child Development

come program as a result of welfare reform re-

main enrolled in Medicaid;

• eliminate asset testing to determine Medicaid
  eligibility;


• guarantee twelve months of continuous Medic-
  aid eligibility for children younger than nine-
  teen years;


• adopt presumptive Medicaid eligibility options
  for children younger than nineteen years, simi-
  lar to the option available for pregnant women;


• ensure that a redetermination of eligibility be
  made before disenrolling any children from
  Medicaid because of changes in their eligibility
  for cash assistance under the Temporary Assis-
  tance for Needy Families program; and


• ensure that children who are removed from
  their homes by the state are immediately en-
  rolled in Medicaid.
  The AAP and other national organizations
  strongly support the expansion of Medicaid because
  of the countless children who have yet to benefit from
  it. The AAP estimated that in 1997, approximately
  4.5 million uninsured children were eligible for Med-
  icaid but were not enrolled. Another 4.6 million chil-
  dren who were privately insured were also eligible for
  Medicaid as a supplement to their private insurance
  but were not enrolled.

The Children Left Behind

While Medicaid’s benefits seem endless, many
may question why so many children do not have the
health insurance that they so desperately need. When
Medicaid was separated from welfare during the mid-
1980s the hope was that children would benefit from
major eligibility expansions. But state eligibility pro-
cedures have been shaped over time by federal rules
that penalize states for enrolling ineligible beneficia-
ries, and the AAP indicates that there has been silence
about the millions of eligible beneficiaries who are
not enrolled. Beginning with the passage of Title
XXI, the AAP has put a call out to pediatricians, other
health-care professionals, and child advocates to as-
sist state Medicaid agencies in providing outreach to
families whose children are uninsured or underin-
sured.

In the United States there are specific groups of
children that are at an especially high risk for being
without health insurance. A national survey in 1998
found that teens, children of color, and children in
single-parent families were at a particularly high risk
for being uninsured. Other research also indicated
that the educational status of adult family members is
a good predictor of a child’s insurance status. For in-

stance, parents who have not completed high school

are likely to work in unskilled jobs lacking health in-

surance benefits, and therefore their children are

most likely to be without health coverage. The Census

Bureau reported that black children had a higher rate

of Medicaid coverage in 1999 than children of any

other racial or ethnic group. The rate for black chil-

dren was 36.2 percent, compared with 30.8 percent

for Hispanic children, 16.7 percent for Asian and Pa-

cific Islander children, and 13.2 percent for white

non-Hispanic children.

In order to increase enrollment in Medicaid,

President Clinton in 1998 launched the Children’s

Health Insurance Outreach Initiative, which gave the

states additional funds and flexibility to find and en-

roll hard-to-reach children. President Clinton’s initia-

tive also challenged the public and private sectors to

educate families about Medicaid and SCHIP. An ad-

ditional step taken by the Clinton administration was

the nationwide ‘‘Insure Kids Now’’ campaign in 1999

to enroll eligible children in Medicaid and SCHIP.

While Title XXI is a significant progression for

U.S. social policy by offering a way to reduce the num-

ber of children who are uninsured, there are many

variables that must coincide for the program to be

successful. The biggest issues that remain are: reach-

ing those who are eligible for Medicaid and educating

families about the importance of health insurance for

their children.

See also: STATE CHILDREN’S HEALTH INSURANCE

PROGRAM

Bibliography

American Academy of Pediatrics. ‘‘Implementation Principles and

Strategies for the State Children’s Health Insurance Pro-

gram.’’ Pediatrics 107 (2001):1214–1220.

American Academy of Pediatrics, Committee on Child Health Fi-

nancing. ‘‘Medicaid Policy Statement.’’ Pediatrics 104

(1999):344–347.

Health Care Financing Administration [web site]. Boston, 2001.

Available from http://www.hcfa.gov; INTERNET.

Perloff, Janet D. ‘‘Insuring the Children: Obstacles and Opportu-

nities.’’ Families in Society: The Journal of Contemporary Human

Services (September 1999):516.

U.S. Bureau of the Census. ‘‘Health Insurance Coverage: Consum-

er Income.’’ Washington, DC: U.S. Bureau of the Census,

1999.

Beth A. Kapes

HEALTHY START

The Healthy Start Initiative, a community-driven

demonstration project begun in 1991, is the largest

federal public health program dedicated to improv-

ing the health of mothers and infants in high-risk

176 HEALTHY START