New Jersey has made significant progress in extending health insurance to poor and middle-class children, but the results lag those seen in many other states and some 70,000 kids still lack coverage.
But a new proposal from the progressive think tank New Jersey Policy Perspective outlines no- or low-cost steps the state could take to end the underinsured gap for those under age 18, ensuring healthcare coverage for all kids, regardless of immigration status. The plan calls for both legislative and regulatory changes that NJPP said would cost less than $70 million annually, after three years, and close to only $10 million in year one.
Key steps involve changing a state statute to allow undocumented children to participate in Medicaid — known here as FamilyCare — and program tweaks to ease enrollment and retention. In addition, a regulatory reform is needed to permit middle-class families who earn too much to qualify to purchase coverage for their children at full cost.
New Jersey once allowed such “buy-ins” to its Medicaid program but ended the option four years ago, a result of federal changes and pressure from then-Gov. Chris Christie, advocates said. Five states, including New York and Pennsylvania, currently offer this policy, according to NJPP.
Avoid the emergency room
Better access to healthcare helps children avoid the emergency room, reduces the impact of asthma, diabetes, or other chronic diseases, helps children succeed in school, and results in more economically stable families and communities, research has shown.
More effective preventive care also reduces costs for the healthcare system over time and greater insurance coverage lessens the need for charity care, which cost the state more than $230 million last year. The New Jersey Hospital Association has long supported efforts to expand coverage, especially for kids.
“Nothing can be more important than covering kids,” said Sen. Joseph Vitale (D-Middlesex), a longtime champion of expanded insurance who on Monday joined leaders from NJPP, the NJHA, New Jersey for Healthcare, the state’s chapter of the American Academy of Pediatrics, and advocacy groups for immigrants and poor communities to announce the report. “We’ll get this done this year,” Vitale added.
Gov. Phil Murphy, a Democrat who took office earlier this month, has underscored the importance of Medicaid and other subsidized health insurance programs. He has also nominated department heads with federal experience in an effort to fend off federal proposals to scale back or reform these systems. On Sunday he signed an executive order requiring state agencies to do more to promote Medicaid programs in an effort to boost enrollment.
Twenty states do better than NJ
The expansion of Medicaid under the Affordable Care Act has reduced the number of uninsured children in New Jersey by about a third, NJPP found, but 3.5 percent of youth still don’t have health coverage. Many are concerned that the Trump administration’s efforts to repeal and replace the ACA will further disrupt the program.
Some twenty other states — including Kentucky, Alabama, and West Virginia — now have lower uninsured rates for minors, NJPP found, and in the Northeast, only Maine has a higher rate of uninsured kids (4.6 percent). In Massachusetts, just 0.9 percent of children are without coverage.
In New Jersey, most uninsured kids live in large urban counties, like Essex and Hudson, but there are also significant numbers in rural counties like Cumberland and Warren. The insurance gap also reflects significant racial disparities; while 2 percent of white youth lack coverage, 3 percent of black kids are without a policy, and 7 percent of Hispanic children are uninsured — in large part because many lack legal status as residents.
As a result, nearly 35,000 of the uninsured youngsters in the Garden State would qualify for Medicaid based on their families’ income level, but cannot enroll given their immigration status. Another 23,000 children here are eligible, but not enrolled, in part because of rules that frustrate potential customers, NJPP said.
Also aimed at families that exceed income limit
An additional 12,000 kids are from families that exceed the income limit but that might opt to buy into the program. This element doesn’t add to the state’s tab, and would cost families an average of $2,200 per year, per child, NJPP said, significantly less than the cost of traditional commercial policy.
Vitale, who chairs the Senate health committee, has offered to sponsor legislation to address the first concern by expanding the Medicaid program to undocumented children. NJPP estimates this portion alone would cost $10 million the first year and some $66.5 million by 2021, when more kids are signed up.
“We realize the state is strapped for cash, but this is eminently doable,” noted Ray Castro, healthcare program director for NJPP. New Jersey’s Medicaid program has a $15 billion budget, at least two-thirds of which is covered by federal funding. Adding immigrants to the program “would be considered a rounding error,” Castro said.
Immigrant families would benefit in many ways from having healthcare coverage for their children, advocates stressed. Without insurance, many undocumented kids go without basic care, either because of poverty or concern about triggering a family’s deportation.
Pay rent or pay for medicine
“That pretty much means our parents have to decide whether to pay rent or to pay for our medicine,” said Juan Garcia, a youth leader for Make the Road New Jersey, who is undocumented. “Immigrant youth are under attack nationwide and the Garden State now has the opportunity to defend us, and stand for us, and say we deserve a chance at a future here.”
Some tweaks to Medicaid’s administration would also have significant benefits, the group said. The report calls for ending a three-month waiting period for some enrollees and eliminating a measure that ejects children after 90 days for non-payment. Three dozen states don’t have these provisions, according to NJPP.
The group also called for streamlining the application process and investing as much as $2 million in better outreach for the program. In addition, they said the state Department of Human Services, which oversees Medicaid, should provide formal updates on its progress to enroll all children.
“The lack of health coverage can be a major cause for poverty,” noted Renee Koubiadis, executive director of the Anti-Poverty Network of New Jersey. “We can and must do better to help low-income children obtain health insurance.”