Getting children the health care they need

The following is the opinion and analysis of the writer:

After moving to Arizona two years ago, I became the medical director of a program that supplies free and low-cost medical services to uninsured Arizona children. School nurses identify kids in need, and we connect them with providers who see them at reduced reimbursement rates.

Most would agree that the aim of this program is a noble one — who wouldn’t want to help sick kids get health care? But I had just moved from Massachusetts, a state with one of the lowest child uninsurance rates in the country. Part of me wondered why this program was even necessary… Are there really that many Arizona kids who don’t have health insurance?

The answer (unfortunately) is yes in this great state I now call home. In 2019, Arizona ranked third in the nation for having the most uninsured children at 9.2%. Research has shown public health insurance improves children’s access to care, their health, and even their long-term educational and economic outcomes. Uninsured children are less able to access essential health services and are thus, at risk for poorer health and other outcomes.

During the COVID-19 pandemic, Arizona’s Medicaid and Children’s Health Insurance Program (CHIP) — AHCCCS and KidsCare — served vital roles in insuring Arizona’s children. By law, Arizonans with AHCCCS/KidsCare had kept coverage since March 2020, causing enrollment in these programs to grow by 30%, with more than 20% of this growth due to children. By August 2022, more than half of Arizona's children were insured via these programs, and the state's child uninsurance rate fell to 8.4%.

However, pandemic protections were removed in April 2023, resulting in an “unwinding” of the Medicaid continuous enrollment provision. This change means Arizona (and the rest of the country) began disenrolling Medicaid members who were no longer eligible or unable to complete the renewal process.

By January 2024, nearly half a million Arizonans were disenrolled from Medicaid, including almost 170,000 children. Notably, 72% of disenrollments occurred because individuals did not complete the renewal process; only 28% were disenrolled solely because they were no longer eligible. Potentially large numbers of people were disenrolled for reasons like outdated contact information or because they could not read English.

Medicaid unwinding has shed new light on the issue of health care coverage in America, leading to the question — why should any child in this country not have health insurance? Why is it that even before unwinding, almost 1 in 10 kids in Arizona weren’t covered?

In 2024, we must get kids who were disenrolled from Medicaid back onto coverage. Providers should encourage families to search for affordable health insurance options on the marketplace at healthcare.gov. We should refer them to resources like Cover Arizona, where they can make appointments to get help with insurance applications.

But what else can be done to make sure more kids in Arizona are insured? On March 1st, the state took a step in the right direction, expanding KidsCare eligibility from 200 to 225% of the federal poverty level. But this threshold is still below the national median of 255%; expanding the income limits further (250%-300%) would mean even more kids could get covered. And, let’s not forget Arizona’s 12,000 undocumented children, who are even less likely to be insured and aren’t eligible for federally funded insurance. Arizona could follow the example of at least a dozen other states and use state funds to cover all income-eligible children, regardless of immigration status.

Children can’t control whether their parents can afford health insurance. Being a parent myself, I can’t imagine what it must be like to be unable to provide health care for my children. Let’s ensure that as many kids as possible in Arizona have health coverage so that they and their families don’t have to worry about getting the care they need.