Nov 26 Highlighting The 2024 State of Children’s Health in Pennsylvania: Post-Pandemic Health Insurance Trends

(November 26, 2024)

Our partners, Pennsylvania Partnerships for Children (PPC), released their yearly report, State of Children’s Health in Pennsylvania on November 19th. The report outlines rates of uninsured children and the impact of ending pandemic area continuous enrollment on PA’s children.

Rates of Uninsured Children: Good News and Bad News

Pennsylvania families can access children’s health insurance with free and low cost options like Medicaid, CHIP, and Pennie, the state based marketplace. However, when choosing a pathway to coverage, families might encounter roadblocks, and ensuring families have all the information about what their child qualifies for remains a challenge.

For the years 2022-2023, we saw a steadying of the rates of uninsured children, which is overall good news for children in the commonwealth. Still, as the report highlights, it’s important to remember that steady rates do not equal progress: too many children in Pennsylvania are still uninsured, and PA continues to have the 5th highest rate of uninsured children nationwide. According to Census data, 6.8% of Pennsylvania children whose families meet the 138% Federal Poverty Level (FPL) Medicaid eligibility criteria are currently uninsured. In addition, even short gaps in coverage can delay preventative care and treatment for chronic conditions, which can result in costly ER visits and missed school.

Locally, Somerset County saw one of the most significant improvements from the prior year, with 3.3% uninsured children, down from 8.6% in 2022. In terms of improving or worsening rates of uninsured children statewide, the rates remained steady over the last year, while regionally there is a mix (detailed below):

Statewide, the number of uninsured children is also a pressing issue. Eight counties, including Allegheny, have 5,000 or more uninsured children. These counties account for over half of all uninsured children in the commonwealth. After Philadelphia and Lancaster, Allegheny County has the third-highest number of uninsured children.

Regionally, Pennsylvania’s neighboring states have seen increases in child uninsured rates since last year. Despite remaining at a steady uninsured rate, Pennsylvania maintains the highest rate of uninsured children among our region, which includes Delaware, Maryland, New York, New Jersey, and West Virginia. This is particularly concerning given our state’s substantial child population of over 2.6 million, which is the sixth largest child population in the country.

Unwinding Impact and Enrollments

Given the end of pandemic era enrollment flexibilities as of April 2023, there was a need for program collaboration between the public coverage systems during the unwinding of continuous coverage. Overall, while we anticipated challenges from this process, Pennsylvania’s steady rate of uninsured children offers some initial relief. However, the full impact of the Medicaid unwinding won’t be clear until the next census data is released next fall.

The report details somewhat positive outcomes in the Medicaid unwinding data analyzed so far: less than 20% of children experienced disruptions to their health coverage in 2023. In 2022-2023, for children under 21 years old, 56% of the processed renewals maintained their Medicaid coverage.

Following the restart of Medicaid eligibility redeterminations, Medicaid enrollment decreased by 9%. Likely a result of the same redeterminations, CHIP and Pennie enrollments increased, with nearly 195,000 children joining CHIP in the past year (a 6% increase).

Of the children enrolled in Pennie, 58% qualify for Medicaid or subsidized CHIP coverage, a total of 25,681 children. While it is wonderful that these children are not uninsured, the question remains whether families have all the information on Medicaid or CHIP when making this choice. It’s important to remember that no family earns too much for CHIP thanks to Pennsylvania’s buy-in program, which allows families with higher incomes to purchase CHIP coverage. While some families pay income-based monthly premiums, over half of CHIP enrollees receive free coverage with no monthly premiums or co-pays.

There is no reason a child in Pennsylvania should not have health insurance access. No-cost and low-cost options allow families to qualify for quality health insurance and give families choice among publicly funded or supported health insurance. However, more needs to be done to educate families on their options to ensure that the choice is an informed one.

Another policy that has impacted the stability in coverage this year is the Federal 12 month continuous coverage requirement. Beginning in January 2024, Pennsylvania, and all other states, were required to implement a full year of coverage for children under age 19 in both Medicaid and CHIP. Going forward, thanks to a recently approved Medicaid waiver, Pennsylvania will provide additional years of continuous eligibility for children under age 6 beyond the 12 months.

Along with PPC, Allies for Children will continue this work to advocate for policies that support children’s access to affordable health insurance and educate families on their options.

For more information about the 2024 State of Children’s Health Report from PPC, visit: https://www.papartnerships.org/report/report-state-of-childrens-health-in-pennsylvania-november-2024/

Cristina Codario, Allies for Children Policy Director