Health Insurance Coverage
Health insurance, whether financed through the private or the public sector, is an essential ingredient for access to care for children with special health care needs. Without health insurance, children are more likely to forgo necessary preventive health care, and acute health care when children are sick can leave their families with overwhelming medical bills.
This section reviews the survey’s findings on insurance coverage among children with special health care needs, including the percent who have health insurance and the type of coverage they have.
For children with insurance, the survey also assessed parents’ perceptions of the adequacy of coverage using three criteria: whether the plan offers benefits and services that meet the child’s needs; whether the family considers the costs to be reasonable; and whether the plan allows the child to see the providers he or she needs.
Finally, this section describes the other programs and services CSHCN use to meet their medical and educational needs, including Supplemental Security Income (SSI), early intervention, and special education.
Insurance Coverage Over the Past 12 Months
The survey asked parents whether CSHCN had insurance in the past 12
months and what kind of insurance they had. Health insurance was defined
as private insurance provided through an employer or union or obtained
directly from an insurance company; Medicaid; Medicare; the Children’s
Health Insurance Program (CHIP); military health care (TRICARE, CHAMPUS,
Overall, 88 percent of CSHCN were reported to be insured for all of the previous 12 months; 12 percent were uninsured for all or some part of the year.
Children from low-income families are more than twice as likely to be uninsured for some or all of the year than those with family incomes of twice the poverty level or more.
Rates of uninsurance are higher among non-Hispanic Black CSHCN and Hispanic CSHCN than among non-Hispanic White CSHCN. Fewer than 10 percent of non-Hispanic White CSHCN were uninsured at any time during the past 12 months, while 14 percent of non-Hispanic Black CSHCN and nearly 20 percent of Hispanic CSHCN reported some period without insurance.
Type of Health Insurance Coverage
Parents were asked what type of coverage their children had at the time of the survey interview: private or employment-based coverage; Medicaid, CHIP, or other public coverage; a combination of private and public coverage; other comprehensive insurance (not including insurance that only covers dental care, vision, or accident care); or none.
Overall, almost 95 percent of families reported that their children had insurance at the time of the interview. Nearly two-thirds of CSHCN were reported to have private or employment-based coverage, 22 percent had public coverage, 8 percent had both, and 5 percent had no insurance.
As expected, the distribution of types of insurance coverage varies across income groups. Among families in poverty, more than two-thirds of CSHCN are covered through public programs such as Medicaid and CHIP, while among children with family incomes above 200 percent of the poverty level, more than 80 percent have private-sector coverage.
Adequacy of Current Coverage
Families were asked three questions about the health insurance coverage of CSHCN with insurance:
In this chart book, those with answers of “usually” or “always” to all three of these questions are considered to have adequate health insurance coverage. All others are considered to have inadequate coverage.
Overall, one-third of CSHCN are reported by their parents to have inadequate coverage by this definition. This varies considerably by income; among the children in the highest-income families, 28 percent reported having inadequate coverage, while among those below the poverty level, 43 percent of CSHCN reported inadequate coverage.
Thus, not only are CSHCN in low-income families less likely to be insured than those with higher family incomes, but when they are insured, this coverage is less likely to meet their needs.
The perceived adequacy of insurance coverage varies by the type of insurance. As the graph on this page shows, children enrolled in public insurance programs (such as Medicaid and CHIP), either alone or in combination with private insurance, are the most likely to report problems with their coverage, as more than 37 percent report at least one problem with their insurance, compared to 32 percent of privately-insured children. Not shown on this graph are the specific components of inadequate care that are the most common among these children: CSHCN enrolled in public programs are almost twice as likely as privately-insured children to have parents who report that benefits do not always meet their needs, and almost twice as likely to report being restricted from seeing the providers they need.
Inadequate insurance coverage also varies by the impact of the child’s condition. Parents of children whose conditions never affect their abilities are the least likely to report inadequate insurance (26 percent), followed by children who are sometimes affected (35 percent have inadequate insurance). Children who are affected usually, always, or a great deal by their conditions are the most likely to report having inadequate insurance, with 44 percent having a plan that does not meet all their needs.
In addition to health insurance, a number of public programs are available to provide essential services and supports to eligible CSHCN. Supplemental Security Income (SSI) provides income support to children with severe disabilities; it was reported that 8 percent of CSHCN receive SSI benefits.
Early Intervention provides specialized therapies to children under age 3 with developmental delays. The survey found that 18 percent of children under age 2 receive these services.*
Special Education programs provide educational and education-related health care services to children ages 3 and up. Of the total population of CSHCN in this age group, it was reported that 28 percent receive these services. This proportion ranges from 36 percent of children in poverty to 23 percent of children with family incomes of 400 percent of poverty or higher.
* Because of the way the question was asked, the survey
cannot determine the number of 2-year-olds receiving Early Intervention