Child Health Plus Enrollment: The Curve Bends Back Up, Sharply

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Having health insurance is critically important for children's health. Uninsured children are much less likely than those with health insurance coverage to receive recommended preventive care or appropriate treatment for chronic conditions. And these may have long-term consequences for health and economic well-being as these children grow into adults. For nearly 30 years, New York State has helped lower-income families afford health insurance coverage for their children through the state's Child Health Plus (CHP) program. This has helped reduce the children's uninsured rate in New York from 12% in 1997 to approximately 2% in 2016. Since Congress passed the federal Children's Health Insurance Program (CHIP) in 1997, substantial federal funds have been available to support the cost of New York's program ($526.5 million in FY 2016), along with other states' coverage programs for children. In September 2017, however, that federal funding will end unless Congress acts to extend it. The gravity of this funding uncertainty is accentuated by the surprising rise in CHP enrollment in every county in New York over the past year, resulting in a statewide jump of 17% between July 2016 and July 2017 (Figure 1).





Note: To visualize geographic differences in ratios, the Jenks optimization method was used to create the “natural breaks” groupings in Figure 1. Natural breaks are based on the distribution of data values, identifying groups with similar values and setting boundaries where there are relatively large differences.

Over the past ten years the monthly enrollment in CHP has fluctuated, rising from 365,005 in July 2008 to 411,066 in July 2011 and then declining steadily over the following four years to a low of 276,881 by July 2015 (Figure 2). The growth from 2008 to 2011 is generally attributed to the recession, and the decline from 2011 through 2015 to an improving economy and changes in federal Medicaid eligibility policy that resulted in some children and adolescents being eligible to enroll in Medicaid rather than CHP. In May 2016, however, monthly enrollment started to rise again, and it increased steadily every month thereafter to 347,855 by July 2017 (Table 1). It is not clear what precipitated this marked jump in enrollment, but one factor may be the implementation of New York's new Basic Health program, the Essential Plan, beginning in the winter of 2016. The Essential Plan offers coverage to adults who are ineligible for Medicaid coverage and whose family incomes are less than or equal to 200% of the federal poverty level. Although children are not eligible for coverage under the Essential Plan, the outreach effort accompanying its launch may have reached families unaware of the availability of CHP.





New York State Regions were compiled using New York counties as follows: NYC: Bronx, Kings, New York, Queens, and Richmond. NYC Metro Area: Nassau, Rockland, Suffolk, and Westchester. Upstate Urban: Albany, Broome, Chemung, Dutchess, Erie, Monroe, Niagara, Oneida, Onondaga, Orange, Putnam, Rensselaer, Saratoga, Schenectady, and Tompkins. Upstate Rural: Allegany, Cattaraugus, Cayuga, Chautauqua, Chenango, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Ontario, Orleans, Oswego, Otsego, Schoharie, Schuyler, Seneca, St. Lawrence, Steuben, Sullivan, Tioga, Ulster, Warren, Washington, Wayne, Wyoming, and Yates.


After September 30th, under federal law, New York will be permitted to draw down any unspent federal funds from prior years to fund CHP, but state officials project that these funds will be exhausted by early 2018. Ready access to comprehensive, consistent health care is central to ensuring that children receive the support they need to develop into healthy adults. New York's commitment to CHP over the years has enabled hundreds of thousands of children to have that access. Whether or not Congress approves new CHIP funding, at what level, and for how long will all have major implications for the future of CHP and for nearly 350,000 current CHP enrollees and their families.

Table 1. CHP Enrollment and Percent Growth in New York State by County, July 2016 and July 2017