Three In Five U.s. Children Enroll In Medicaid And Many Experience Uninsurance By Age 18

By property 18, 3 successful 5 U.S. children person enrolled successful Medicaid aliases nan Children's Health Insurance Program (CHIP), and 2 successful 5 person knowledgeable a play of being uninsured, according to a microsimulation exemplary developed by researchers astatine Harvard T.H. Chan School of Public Health. The study, nan first to estimate cumulative security acquisition complete nan afloat people of childhood, highlights nan wide scope of Medicaid and CHIP, programs that person precocious undergone important argumentation changes. 

In July 2025, nan Centers for Medicare and Medicaid Services stopped approving Section 1115 waivers for multiyear continuous nationalist security eligibility among children. In nan aforesaid month, nan national fund reconciliation measure was signed into law, which, according to Congressional Budget Office projections, will trim Medicaid backing by $1 trillion and trim enrollment by 10 to 15 cardinal people. Our study provides a valuable baseline for knowing nan grade to which U.S. children's semipermanent security sum whitethorn beryllium affected by these sweeping changes."

Ye Shen, corresponding author, student successful nan Harvard PhD Program successful Health Policy

The study will beryllium published Sept. 24, 2025, successful JAMA.

Fragmented wellness security claims information and short follow-up periods successful nationalist surveys person hampered efforts to way puerility security sum complete agelong periods successful nan U.S. To reside these limitations, nan researchers mixed nationalist natality, socioeconomic, demographic, and security information successful a microsimulation exemplary to make individual security trajectories from commencement done property 18 for a nationally typical cohort of children. The researchers past estimated cumulative security outcomes complete 18 years nether argumentation conditions akin to those betwixt 2015 and 2019, aft nan sum description s of nan Affordable Care Act but earlier nan impermanent policies introduced during nan COVID-19 nationalist wellness emergency successful 2020.

The study's estimates propose that by their 18th birthday, 61% of children person enrolled successful Medicaid and CHIP, and 42% person knowledgeable gaps successful coverage. The researchers besides estimated that disruptions to sum were much communal successful states that did not grow their Medicaid programs. Among children calved into Medicaid aliases CHIP sum successful non-expansion states, 59% knowledgeable periods of being uninsured, compared to 36% of their counterparts successful description states. When comparing Medicaid and CHIP income eligibility precocious levels crossed states, states pinch nan astir restrictive thresholds saw nan highest stock of sum disruptions among children covered successful Medicaid aliases CHIP astatine birth.

"Upcoming changes to Medicaid could impact a important information of children and worsen already important security gaps," said elder writer Nicolas Menzies, subordinate professor of world wellness and module personnel successful nan Center for Health Decision Science. "We're peculiarly worried astir definitive nonaccomplishment of nationalist security eligibility for noncitizen children; spillover effects done parental Medicaid sum losses owed to activity requirements and much eligibility checks; and state-level cuts to Medicaid."