On November 2nd, 2021, First Focus on Children hosted a Congressional briefing, “Covering all Children – the Path Forward.” Panelists included, Kelly Whitener, Georgetown University McCourt School of Public Policy’s Center for Children and Families, Dr. Glenn Flores, Holtz Children’s Hospital and Dr. David Rubin, Population Health Innovation at Children’s Hospital of Philadelphia.

The panelists described the challenges that prevent children from enrolling in health care programs and the policy barriers that are caused by Medicaid and Children’s Health Insurance Program (CHIP). The speakers explored measures to expand access to care for children and innovations that would address racial disparities in children’s health.

First Focus President Bruce Lesley moderated the discussion and began the briefing with opening comments by Congresswoman Kathy Castor (D-FL). Castor is the co-chair of the Children’s Healthcare Caucus in the House of Representatives. Congresswoman Castor introduced the panel by emphasizing the importance of expanding Medicaid, supporting children that have complex medical issues, and boosting children’s healthcare.

Panelist Kelly Whitener began the panel discussion with an overview of children’s coverage trends in the United States. From 2016-2019, the number of uninsured children increased severely. Whitener stressed that children’s uninsured rates vary due to factors including state-residency, income, age, race and ethnicity, and citizenship status. American Indian/Alaskan Native and Latino children are among the highest rate uninsured. However, a component of the issue is not in eligibility, but enrollment in programs like CHIP or Medicaid.

To address this issue, Whitener suggests that legislation allow for all newborns leave the hospital with an insurance card, multi-year continuous coverage, permanent funding for CHIP, increased income eligibility, and removal of restrictions related to citizenship status. Furthermore, she highlighted the importance of outreach and enrollment including efforts like application assistance, partnering with trusted, community-based organizations, and maximizing Medicaid/CHIP enrollment in schools.

Dr. Flores spoke about the outcomes of children being uninsured and the insurance outreach program, Kids HELP. Specifically, Dr. Flores focused on Texas, because it has the highest percentage of uninsured children, resulting in undiagnosed health problems and delayed immunization. Dr. Flores found that many Texans may be unaware of state insurance programs or fear applying due to their citizenship status. In these cases, traditional outreach may not be the most successful in convincing individuals. The state of Texas holds nearly 1 in 4 uninsured children in the United States reaching nearly 1 million children.

As an attempt to solve this problem, Dr. Flores conducted a study called Kids HELP where he paired uninsured parents with a Parent Mentor (PMs). PMs are minority parents enrolled in CHIP or Medicaid who have children with similar health issues to the child of the parent they are paired with. PMs help guide the mentee parent through the CHIP or Medicaid application process and show them how CHIP or Medicaid plays out when going to a doctor’s office. Dr. Flores found that his study was more effective than traditional Medicaid/CHIP outreach. Additionally, he produced a cost analysis that illustrated expenses—PM programs are paid for by grants costing $636 per child and end up saving $6,045 per child yearly.

Dr. David Rubin, longtime child advocate discussed logistical barriers to affordable healthcare and components for successful CHIP and Medicaid programs. Dr. Rubin clarified the misconception that employer-sponsored health care is affordable for families. He points out that premiums have substantially increased over the past 10 years and family coverage may not be included.

During the question-and-answer period discussion focused on mental health, CHIP, and Build Back Better reconciliation legislation. All panelists agreed Build Back Better’s expansion of CHIP and Medicaid should cover behavioral and mental health services. Panelists acknowledged that closing the insurance gap needs to include all individuals, regardless of citizenship.