1.) Because of the Medicaid expansion, however, the decline in employment-based insurance for children did not lead to an increase in the proportion of uninsured children. 2.) Poor children had a smaller decline in employment-based insurance than near-poor children and a large increase in Medicaid coverage. As a result, the percentage of poor children who were uninsured actually declined from 25 percent in 1989 to 20 percent in 1993. The Medicaid Expansion Increased the Number of Medicaid Children in Working and Non-AFDC Families, Among Other Changes

Because of policy changes to expand children’s eligibility, Medicaid has become a more important source of insurance for children who were less likely to get Medicaid in the past, such as children in working families. By 1993, more than half the children on Medicaid had a working parent, and almost half did not depend on AFDC. 3.) 4.) Despite this decline, the South remains the region with the highest percentage of uninsured children and the largest number of poor, uninsured children. The expansion in Medicaid coverage for children in working families did not decrease the percentage of uninsured children with a working parent. 5.) 6.) 7). At least one-quarter of uninsured children in 1993—2.3 million—had family incomes that should have made them eligible for Medicaid. Another 16.9 percent—2.3 million children—were uninsured. Growth in Medicaid Enrollment for Children Greatest in the South

Between 1989 and 1993, the number of children on Medicaid increased in all regions, but the greatest increase occurred in the South. When Medicaid coverage became mandated by age and poverty, the greatest number of children benefiting were in the South. Either parent worked full time/full year.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the status of health insurance for children, focusing on: (1) the impact of the Medicaid expansion on children's health insurance coverage since 1989; (2) changes in the demographic profile of children enrolled in the Medicaid program and uninsured children since the Medicaid expansion; and (3) the number of uninsured children who might be eligible for Medicaid.

What GAO Found

GAO found that: (1) policy changes helped increase the number of children enrolled in Medicaid by 4.8 million between 1989 and 1993, but the overall number of uninsured children did not decline because employment-based coverage for adults and children declined during the same period; (2) children were not as affected by the loss of employment-based insurance as adults because of expanded Medicaid coverage; (3) the percentage of poor children who were uninsured declined from 25 percent in 1989 to 20 percent in 1993, while the percentage of near-poor children who were uninsured increased during that time; (4) the Medicaid expansion increased the enrollment of children less likely to be on Medicaid and by 1993, more than half of Medicaid children had a working parent and almost half were not receiving Aid to Families with Dependent Children benefits; (5) the greatest increase in coverage was among children with at least one full-time working parent; (6) the South region had the greatest increase in the number of children enrolled in Medicaid, although it still has the greatest number of uninsured children; and (7) at least 2.3 million uninsured children were eligible but not enrolled in Medicaid because their parents were unaware of their eligibility or had difficulty in applying for Medicaid coverage.