TEXAS - Center For Children and Families

1 TEXAS . Snapshot of Children 's Coverage How Medicaid, CHIP, and the ACA Cover Children Children 's health insurance coverage How Kids Are Covered has reached historic levels in the and TEXAS , Medicaid is a primary source of thanks to Medicaid, CHIP, and the ACA. coverage for Children . Each state has the flexibility to design its program within federal guidelines and receives federal matching funds. For Children , 95%. Medicaid provides guaranteed coverage, 91% pediatrician-recommended services, and 91%. cost-sharing protections. The Children 's Health Insurance United States Program (CHIP) builds on the foundation 83%. TEXAS of Medicaid to cover Children in working Families who are not eligible for Medicaid 2008 2009 2010 2011 2012 2013 2014 2015. and lack access to affordable private coverage.

2 Each state designs its program Medicaid million Marketplace within federal parameters but all CHIP. programs provide affordable coverage Children in TEXAS relied on Medicaid and CHIP. at some point in FY 2016 to access the health 144,000 with pediatric-appropriate benefits and networks. Nearly half (24) of all states care they needed to be healthy Children in TEXAS were enrolled in Marketplace plans provide Medicaid benefits to all Children CHIP million at the end of the 2016 open enrollment period enrolled in CHIP. The Affordable Care Act (ACA). established marketplaces where Families can purchase health insurance and receive financial assistance. Marketplace Medicaid and CHIP serve TEXAS 's most plans provide essential health benefits, vulnerable Children .

3 Including pediatric services like dental A large share of at-risk Children rely on public coverage, as reflected by and vision care. the percentage of TEXAS Children in each group below that depend on Medicaid and CHIP for health care they need to thrive: Sources of Children 's Coverage in TEXAS 76% Children living in or near poverty. Infants, toddlers, and pre-schoolers 47% during the early years that are key to their healthy development and school readiness. 41%. Children with disabilities or other special 38%. 40% health care needs such as juvenile diabetes, congenital heart conditions, or asthma. 5%. Children in foster care who face poverty, 9% 6%. family dysfunction, neglect, and abuse 100% that result in high rates of chronic health, Medicaid and CHIP.

4 Employer-Sponsored Insurance emotional, and developmental problems. Purchased directly from an Insurer, including Marketplace plans Newborns in Families to assure a healthy 54% delivery and strong start during their critical first Other including Medicare, Tricare, VA. year of life. Uninsured Medicaid and CHIP are Medicaid provides critical to Children 's affordable access healthy development to the care Children and success in life. need. Medicaid covers preventive services including well-child Administrative costs in Medicaid check-ups, immunizations, and dental care. Through at the national level are half the the program's definitive standard of care for Children rate typical in private insurance. 74%. known as Early and Periodic Screening, Diagnostic and In 2015, Children accounted Treatment (EPSDT) Medicaid provides Children with for 41 percent of individuals access to the care they need at a cost their parents enrolled in Medicaid nationwide can afford.

5 EPSDT covers a comprehensive array of of all Medicaid/CHIP but represented only 19 percent services for Children , including developmental, vision of Medicaid spending, with an enrollees in TEXAS and hearing screenings, so that health problems and average annual expenditure per developmental delays can be diagnosed and treated as are Children . child of $3,389. early as possible, or averted altogether. Medicaid helps Children grow up to reach their full potential. Children enrolled in Medicaid: 1040. $$. $. Miss fewer school Do better Are more likely to Grow up to be Earn higher Pay more in days due to illness in school graduate high school healthier as adults wages taxes or injury and attend college What's at Stake? Protect Children 's Coverage Keep Medicaid Strong Support CHIP Funding The ACA enacted critical protections that Medicaid is a federal-state partnership CHIP funding expires at the end of also benefit Children and young adults that guarantees coverage for the most fiscal year 2017.

6 CHIP works because covered by private insurance: vulnerable Children , and covers 35 it stands on the shoulders of Medicaid. million Children in the Restructuring CHIP funding must be extended to zz Young adults between the ages of 19. Medicaid with reduced federal funding provide certainty and stability for and 26, an age group with the highest will force states to pit Children 's needs Families who depend on it. uninsured rates before the ACA, are against other vulnerable groups, able to stay on their parents' health including individuals with disabilities and plan. the elderly. Currently federal matching zz Children with asthma, cancer, or disabilities cannot be excluded from coverage due to their pre-existing funds to states expand or shrink as the number of individuals enrolled or the cost of providing services changes based 51% of total condition.

7 On need. Proposals like block grants or federal funds zz Insurance companies cannot impose per capita caps that set limits on federal received by annual or lifetime benefit limits, which Medicaid funding which accounts for 51 TEXAS would be especially hard on Families percent of all federal funding received by is for Medicaid. with Children who have special health TEXAS will shift financial risk to the state care needs. to fill the gaps. This fact sheet was created by the Georgetown University Center for Children and Families and the American Academy of Pediatrics. For data sources used, see For more information on Medicaid, CHIP, and the ACA, visit our websites at.