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Factors Influencing Health Insurance Coverage |
The makeup of a state’s population is the starting place for understanding health needs.
Child Population
Total child population is the backdrop for understanding the size of the CSHCN population. Note this data source represents children ages 0-18 while the 2020-2021 NSCH data represent children ages 0-17.
US total population of children excludes Puerto Rico.
US total population of children excludes Puerto Rico.
Race/Ethnicity
Special Health Care Needs
These figures reflect parent responses to "screener" questions about the child's use of or need for services. Learn more about the screener at
http://www.cahmi.org/projects/children-with-special-health-care-needs-screener/
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about coverage and financing strategies that address inequities https://ciswh.org/project/the-catalyst-center/financing-strategy/inequities/.
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about coverage and financing strategies that address inequities here .
This measure was scored as the count of difficulties children experience from a list of 12 functional difficulties, which do not include behavioral or mental health difficulties. The difficulties are asked about as two different types of questions: (a) During the past 12 months, whether the child had frequent or chronic difficulty with breathing or other respiratory problems; eating or swallowing; digesting food, including stomach/intestinal problems, constipation, or diarrhea; repeated or chronic physical pain, including headaches or other back or body pain; using his/her hands (0-5 years); coordination and moving around (0-5 years) , and (b) Whether the child has serious difficulty concentrating, remembering, or making decisions (6-17 years); serious difficulty walking or climbing stairs (6-17 years); difficulty dressing or bathing (6-17 years); difficulty doing errands alone, such as visiting a doctor’s office or shopping (12-17 years), deafness or problems with hearing; and blindness or problems with seeing, even when wearing glasses.
Low Birth Weight
Special Education
Age group of children served is 3 to 21-year-olds.
Data for 5- to 21-year-olds in Lousiana are for 2019-2020 because more recent data were not available.
Income
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Education
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information, click here.
Employment
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here. National Survey of Children's Health data for this indicator was collected for all states but not publicly reported for all states.
Financial Impact of Caregiving
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Out of pocket costs include co-pays and amounts from Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), for medical, health, dental, and vision care during the past 12 months. This does not include premiums.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Medicaid Eligibility
Although they must meet or exceed a federally set standard, states have substantial discretion in setting income limits on Medicaid eligibility. States with higher maximum income limits cover a broader population.
Children's Medicaid eligibility includes Title XXI CHIP funding for states that expanded Medicaid with CHIP funds.
All eligibility limits reflect the MAGI-converted income standards, which includes the five percentage point disregard applied to the upper limit for Medicaid coverage for each group.
Learn about the coverage and financing of Medicaid Buy-Ins at https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/
Federal Match for Medicaid
Data in this section broadly characterize child health services in each state in terms of capacity and utilization. Use these data to understand the immediate context for services to CYSHCN in each state.
Health Care
Early Intervention Eligibility
Some states may serve infants and toddlers who are “at-risk” of developmental delay in their Early Intervention programs using state funds. The data presented in this indicator refers to whether states use the Federal Part C definition of at-risk under the IDEA.
Within federal guidelines, states have broad discretion in setting Early Intervention eligibility.
Mental Health
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about the coverage and financing of Behavioral Health at http://cahpp.org/project/the-catalyst-center/financing-strategy/behavioral-health/ .
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
This indicator reflects coverage and access to all needed care for children with emotional, behavioral, or developmental issues. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Private insurance plans are required by law to cover mental health services on par with physical health services. Medicaid is required to cover mental health services for enrollees under the age of 21 under the EPSDT benefit. However, not every mental or behavioral health service a child might require is covered, even if it is a plan benefit. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Interpret with caution: for certain states the estimate may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information about why, click here.
Private insurance plans are required by law to cover mental health services on par with physical health services. Medicaid is required to cover mental health services for enrollees under the age of 21 under the EPSDT benefit. However, not every mental or behavioral health service a child might require is covered, even if it is a plan benefit. Learn more about the coverage and financing of Behavioral Health at https://ciswh.org/project/the-catalyst-center/financing-strategy/behavioral-health/
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Oral Health
Vision Testing
Testing location responses are not mutually exclusive, because children may have had their vision tested at multiple locations, therefore percentages may add up to more than 100%.
Data for the vision screening location subindicators above can be found in the following three separate National Survey of Children's Health data queries.
Received vision screening at eye doctor or specialist office: https://www.childhealthdata.org/browse/survey/results?q=8621&r=1
Received vision screening at pediatrician or general doctor’s office: https://www.childhealthdata.org/browse/survey/results?q=8622&r=1
Received vision screening at school: https://www.childhealthdata.org/browse/survey/results?q=8624&r=1
Testing location responses are not mutually exclusive, because children may have had their vision tested at multiple locations, therefore percentages may add up to more than 100%.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Data for the vision screening location subindicators above can be found in the following three separate National Survey of Children's Health data queries.
Received vision screening at eye doctor or specialist office: https://www.childhealthdata.org/browse/survey/allstates?q=8621&g=921
Received vision screening at pediatrician or general doctor’s office: https://www.childhealthdata.org/browse/survey/allstates?q=8622&g=921
Received vision screening at school: https://www.childhealthdata.org/browse/survey/allstates?q=8624&g=921
Foster Care
School-Based Health Services
Health insurance coverage is the key to ongoing access to health care in the US. It is strongly associated with the likelihood that a child will receive basic primary and preventive care, that health problems will be identified and treated early and continuously and that a child with special health care needs will have a medical home that assures and coordinates access to specialty care and community resources. In general, the data elements presented here can form the foundation for any discussion of children’s health care financing and for financing of care for CYSHCN in a state.
Uninsured
For certain states, estimates are based on sample sizes too small to meet standards for reliability or precision. Please check the original data source to confirm whether this applies to the state data you are interested in.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of CHIP at https://ciswh.org/project/the-catalyst-center/financing-strategy/chip/
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Underinsured
Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.
Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.
According to The National Survey of Children's Health methodology adequate insurance is measured by the following criteria: child currently has health insurance coverage AND benefits usually or always meet child's needs AND usually or always allow child to see needed providers AND either no out-of-pocket expenses or out-of-pocket expenses are usually or always reasonable. If a child has inadequate insurance, their insurance did not meet all four of the criteria above.
Learn more about the coverage and financing of Medicaid Buy-Ins at https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Relatively few CYSHCN are uninsured. However, private coverage is often limited in the scope of benefits, the depth at which they are covered and the amount of associated cost-sharing. Thus, in many states, underinsurance is the major financial barrier to health care access for CYSHCN.
Private Insurance Coverage
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Public Coverage: Medicaid, CHIP and SSI
Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in Medicaid and CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in Medicaid and CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different
methodology.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Children are individuals age 18 and younger. The enrollment totals represent the unduplicated number of children ever enrolled in CHIP at any point during the fiscal year. Therefore, enrollment totals may seem higher than other sources of enrollment data that use a different methodology.
Children under age 18
Dual Public and Private Coverage
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Dual coverage is an option in states which permit privately insured families to enroll their children in Medicaid in order to receive supplemental coverage, sometimes known as "wrap-around" coverage. This type of secondary Medicaid enrollment may be offered free or through the payment of premiums based on a sliding scale. Dual coverage helps address underinsurance, which is a significant problem for many privately insured CYSHCN whose coverage is too limited to meet their health needs.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. CSHCN with more complex health needs are defined as having functional limitations (alone or in combination with other qualifying needs), above-routine use of services or use of specialized services (no other qualifying needs on CSHCN Screener), or using prescription medication AND above-routine use of services.
Health Care Reform
The term Health Insurance “Exchange” is also used interchangeably with Health Insurance “Marketplace.”
Financing
National Performance Measures Chosen by State
Fifteen National Performance Measures (NPMs) across five population health domains were established for the Title V MCH Services Block Grant program. Based on its identified priority needs, States and territories select a minimum of five NPMs for programmatic focus. For each of these selected NPMs, States develop at least one related Evidence-based or –informed Strategy Measures (ESMs) to assess and demonstrate the impact of its State Title V strategies on the NPM.
The total number of states who selected each NPM above reflects the 50 states, the District of Columbia, and Puerto Rico; it does not include other territories that may have selected these NPMs.
To learn more about the NPMs, go to https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/NationalPerformanceMeasures
The total number of states who selected each NPM above reflects the 50 states, the District of Columbia, and Puerto Rico; it does not include other territories that may have selected these NPMs.
To learn more about the NPMs, go to https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/NationalPerformanceMeasures
Federal MCHB Core Outcomes for CSHCN
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: The percent of children, ages 0 to 17 who are continuously and adequately insured.
Complexity of health care needs is determined by responses on CSHCN screener. According to The National Survey of Children's Health methodology CSHCN with more complex health needs are those that report one or more of the four CSHCN screening criteria addressing elevated need or use of specialized services, therapies, or functional limitations.
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Corresponds with the MCHB Block Grant Performance Measure: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services necessary to make transitions to adult health care. Learn more about the coverage and financing of transition services at http://cahpp.org/project/the-catalyst-center/financing-strategy/transition-services/
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of transition services at https://ciswh.org/project/the-catalyst-center/financing-strategy/transition-services/ .
Interpret with caution: for certain states the estimate displayed may not be reliable. Please check the original data source to confirm whether this applies to the state data you are interested in. For more information click here.
Learn more about the coverage and financing of transition services at https://ciswh.org/project/the-catalyst-center/financing-strategy/transition-services/.
Approved Medicaid Emergency Authorities
Data accurate as of March 5, 2021. 1135 Waiver authorities are available during any public health emergency (PHE). The provisions presented here were approved through authorities available during the COVID-19 PHE. Additional waiver authorities approved during the COVID-19 PHE can be seen here. For more information on emergency waiver authorities during the COVID-19 PHE and their impact on CYSHCN, please see these Catalyst Center fact sheets .
Data accurate as of March 5, 2021. Section 1915c Appendix K Waiver authorities are available during any public health emergency (PHE). The provisions presented here were approved through authorities available during the COVID-19 PHE. Additional waiver authorities approved during the COVID-19 PHE, can be seen here. For more information on emergency waiver authorities during the COVID-19 PHE and their impact on CYSHCN, please see these Catalyst Center fact sheets.
This project (U1TMC31757) is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $500,000, with no financing by nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government; HRSA Project Officer Sarah Beth McLellan.