child care - Digital Library Collections

......._---'T;..;;.;;H....;;E STATE OF AMERICA'S CHILDREN YEARBOOK 1998
and 10 million in 1975 to 20 million in 1996. The
decline in private coverage for children, however,
has begun to overshadow the Medicaid expansions.
As a result, the number and percentage of uninsured
children have risen to historic levels.
Changes in Medicaid. In 1973 Medicaid coverage
was largely tied to whether a family received
cash assistance. In most states, children and pregnant
women were denied Medicaid if their family
income was too high to qualify for Aid to Families
with Dependent Children (AFDC), even when
that income was substantially below the federal
poverty line.
Dramatic changes occurred in the mid-1980s.
The federal government fIrst permitted and then
required states to extend Medicaid to large numbers
of previously uninsured children and pregnant
women from low-income, working families, and
many states went beyond the minimum federal requirements.
Medicaid eligibility was also expanded
in many states to include numerous children with
disabilities, including those from moderate-income
families. Currently Medicaid covers one in four
American children, including a large proportion of
newborns and children with disabilities.
The benefIts provided under Medicaid also expanded
considerably (at least on paper) with the
1989 enactment of Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) requirements
that children covered by Medicaid must receive
any medically necessary health care. The 1989 provisions
require states to provide children with services
that may not be covered for other age groups
under state Medicaid programs.
The move to managed care. The country's basic
health care delivery system has undergone fundamental
change over the past 25 years. In the 1970s
most Americans received health care through feefor-service
insurance. They could seek care from
any provider, and insurers reimbursed for services
provided. In recent years increasing numbers of
families have been enrolled in managed care plans,
which offer more limited choice of providers and
often reimburse for set fees regardless of the services
provided.
The era ofmanaged care has brought new challenges.
Instead ofreceiving care from solo or group
physician practices or from nonprofIt community
hospitals, many families must now rely on forprofIt
corporate entities of increasing size. In the
• In 1996, 11.3 million children through age 18 had no health
insurance-the highest number ever recorded by the Census
Bureau. Seventy percent af all Americans added to the ranks af the
uninsured that year were age 18 or younger.
• Ninety-two percent of uninsured children have at least one working
parent; 66 percent have a parent who warks full-time and
year-round.
• In 1996 more than 40 percent of Medicaid beneficiaries were
enrolled in managed care plans; as recently as 1991, fewer than
10 percent were enrolled.
• By 1996, 78 percent of all 2-year-olds were fully immunized, up
from 55 percent in 1992.
• Infant mortality is at its lowest level ever (7.6 deaths per 1,000 live
births in 1995). Although maternal and child health indicators have
impraved among Black children since 1991, their infant mortality
rate (15.1 per 1,000) remains disturbingly high.
22 CHI L D R EN'S D E FEN S E F V N D