By Anna Strong, Arkansas Advocates for Children and Families
Arkansas Advocates for Children and Families recently published an update on our state’s
efforts to ensure that all children have health coverage. The best news in “Crossing the Finish
Line: Cutting the Red Tape in 2011” is that, despite a recession and an increasing child poverty rate (currently
over 26 percent in Arkansas), our rate of uninsured children fell to just 7.3
percent in 2010. ARKids First, our CHIP program, has kept children covered
through families’ job losses or dropped coverage. New and better data from the American Community Survey
allows us take a closer look at our state’s 54,000 uninsured children and will
guide further efforts to help Arkansas cross the finish line.
We know children in families just above the income
threshold for ARKids First have the hardest time getting coverage. Over 10
percent of children from 200-250 percent FPL are uninsured. Arkansas lawmakers passed a bill in
2009 to extend ARKids First to this group, but budget constraints during the
recession postponed implementation.
Percent of Arkansas Children Under 19 Who are Uninsured,
by Income
Source: Unpublished runs from the Annie E.
Casey foundation for Children Under Age 19
The data has also shown us that the northwest corner of the state, typically regarded as a wealthier area, actually has the highest rate of uninsured children in Arkansas. Up to 11 percent of children in some counties in that region are uninsured.
We are doing a great job of covering young children. Only 4 percent of children under 6 are uninsured. But our school-age youth, especially 18-year-olds, don’t seem to stay covered as they age out of early childhood programs that require physical exams that can be covered by ARKids First. A child’s race matters, too. For children eligible for ARKids First based on income, Hispanic children are disproportionately uninsured at 14.3 percent. The following graph shows, however, that we do a much better job of covering African-American and White children.
Percent of Uninsured Children under 200% of FPL within Racial/Ethnic Groups
Source: Unpublished runs from the Annie E. Casey foundation for Children Under Age 19
Data from state agencies tells us that access to care is
extremely important. In many
counties in Arkansas, some children on ARKids First and Medicaid do not have
the required primary care physician on record, evidencing the struggle to find
regular, consistent access to a provider.
We also know that thousands of children – 28,000 in 2010 – fall off
ARKids First each year for reasons other than eligibility. Act 771 was passed in 2011 to help
reduce the red tape in ARKids First through Express Lane enrollment through
other programs, paperless renewals, and 12-month continuous coverage. This legislation, as well, has yet to
be implemented.
As the third anniversary of CHIPRA has come and gone, and
more of health reform’s promises emerge on the horizon, we’ve reflected on how
we can do a better job of crossing the finish line here in Arkansas. Of course
we want to do the obvious – implement existing legislation that will help
families get covered and protect Medicaid funding in tough economic times. But this data gives us direction for
delving into policy issues to cover our uninsured children.
For example, Arkansas could take advantage of the ICHIA
option in CHIPRA, which allows states to cover lawfully-residing immigrant
children before the current five-year wait. This will help cover the growing Hispanic population as well
as Arkansas’s sizable Marshallese community that resides in the northwest part
of the state. Under a special
compact, people born in the Marshall Islands are technically “non-immigrants”
who can live and work in our country but have no option to become U.S.
citizens. The ICHIA option would
allow their children coverage for the first time.
Using the state’s Coordinated School Health program and
school-based health centers to reach the 9% of school-age children who are
uninsured is another sensible way to cover more kids. And with health reform, it’s key that AR’s
federally-facilitated “partnership” exchange works for families in complex
coverage situations and that outreach programs reach uninsured Arkansans.
We have the data and the tools at our fingertips. It’s time we take the final steps to
cover all children and families in Arkansas.