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J. HEALTH INSURANCE COVERAGE
Levels of health insurance coverage among Early Head Start children were higher than those among low-income children in general, but some children were uninsured. According to parents, most Early Head Start children (87 to 91 percent) were covered by Medicaid or private health insurance at each of the follow-up interviews (Table 8). Nationally, 79 percent of children under 18 in families with incomes below the poverty level were covered by health insurance in 1996 (Pamuk et al. 1998). The proportion of Early Head Start children reported to be covered by some health insurance declined slightly over time, from 91 percent approximately 6 months after enrollment to 87 percent approximately 28 months after enrollment.
| Months Since Enrollment | |||
|---|---|---|---|
| 7 Months | 16 Months | 28 Months | |
| Percentage of Children
with Any Health Insurance Coveragea |
91.3 | 86.8 | 86.7 |
|
78.7 | 66.5 | 61.8 |
|
23.7 | 30.8 | 32.5 |
| Percentage
of Primary Caregivers with Any Health Insurance Coverage |
70.1 | 71.1 | 70.4 |
|
51.8 | 45.9 | 38.8 |
|
25.9 | 30.5 | 24.5 |
| Sample Sizeb | 957-963 | 950-951 | 1,075-1,076 |
| Source: Parent services follow-up interviews completed an average of 7, 16, and 28 months after enrollment for families who completed the 28-month follow-up interview. | |||
| aSome families reported having both Medicaid and private health insurance. | |||
| bRange reflects minimum and maximum sample sizes for items in table. | |||
Children were more likely to be covered by Medicaid than by private health insurance. Over time, as more parents became employed, Medicaid coverage declined and private insurance coverage increased. Reported Medicaid coverage declined from 79 percent about 7 months after enrollment to 62 percent about 28 months after enrollment. During the same period, reported private health insurance coverage rose from 24 percent to 33 percent. The rise in private health insurance did not fully compensate for the loss of Medicaid coverage over time. Children who were not covered by health insurance were much more likely than those who were covered to be Hispanic children with mothers who had not completed high school or a GED.
Children in home-based programs were more likely than children in other types of Early Head Start programs to have Medicaid coverage, while children in center-based programs were much more likely to be covered by private health insurance, consistent with differences in employment among families in the two types of programs. Approximately 28 months after enrollment, for example, 65 percent of children in home-based programs were reported to have Medicaid coverage, compared with 57 percent of those in center-based programs and 61 percent of those in mixed-approach programs. At the same time, 44 percent of children in center-based programs were reported to have private health insurance coverage, compared with 29 percent of those in home-based programs and 31 percent of those in mixed-approach programs.
Early Head Start parents were less likely than their children to be covered by health insurance. About 70 percent of parents reported that they were covered by Medicaid or private health insurance, and this level of coverage remained constant at each follow-up interview. This level of coverage is about the same as that for all low-income mothers with incomes under 200 percent of the federal poverty level in 2000 (Hoffman and Pohl 2002).
Over time, parents’ health insurance coverage shifted from Medicaid to private health insurance, consistent with the increases in parents’ employment over time (ACF 2002). Medicaid coverage of parents declined over the follow-up period, from 52 percent about 7 months after enrollment to 39 percent about 28 months after enrollment. At the same time, private health insurance coverage of parents increased from 26 to 35 percent. The drop in Medicaid coverage probably reflects, in part, the less generous Medicaid eligibility criteria for women who are not pregnant.
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