Adequate Insurance - Children in California

California

Maintaining continuous and adequate insurance is essential for everyone, especially children during their formative years. However, nearly one-third of children in the United States are underinsured — meaning that although they have health insurance, their coverage does not adequately cover a sufficient portion of their care or health expenses. Compared with adequately insured children, those who are underinsured have more health care disadvantages, including: 

• Delayed or forgone care.
• Lack of a personal doctor.
• Difficulty obtaining needed specialist care.
• Difficulty receiving needed referrals, care coordination and family-centered care — the components of a medical home.

Being underinsured can leave a family vulnerable to the financial risk of medical expenses resulting from illness or disease. A family whose health insurance has a high deductible (meaning they must spend a large amount on health care before their insurance benefits kick in) or low coverage (meaning they pay more to access needed benefits) may struggle to pay their bills. These characteristics contribute to high out-of-pocket costs and are the main drivers of rising childhood underinsurance rates, according to a 2021 study. The study found that an increasing number of Americans with health insurance still cannot afford medical care.

According to America's Health Rankings analysis, populations more likely to have adequate health insurance include:

• Children with a caregiver who graduated from high school compared with children who had caregivers with a college degree, some post-high school education or less than a high school education.
• Children without special health care needs compared with children with special health care needs.
• Multiracial and Black children compared with Hispanic, Asian and white children.

Additional research shows that children under age 6 are more likely to have adequate health insurance compared with children age 12 and older.

Options to improve the adequacy of insurance among children include expanding or enhancing Medicaid (adopted by 40 states and Washington, D.C.) and/or the Children’s Health Insurance Plan (CHIP) (established in all 50 states and Washington, D.C.). The American Medical Association (AMA) recommends expanding eligibility for premium tax credits to help individuals with incomes up to five times the federal poverty level afford health insurance, while maintaining a structure that provides more aid for those with lower incomes. Additionally, the AMA suggests enhanced premium tax credits for young adults, which would incentivize participation in the health insurance market, thereby increasing coverage and driving down costs for everyone.

The Commonwealth Fund has an interactive map of actions each state in the U.S. is taking to improve access to adequate health insurance and suggests Congress approve a state plan option for multiyear continuous eligibility for children to reduce Medicaid churn. Medicaid churn refers to people cycling on and off coverage, not because they are ineligible, but because of fluctuating income, barriers to renewal or other temporary reasons. Medicaid churn contributes to missed and delayed care and higher costs for individuals and the broader healthcare system.

Adequate insurance among children is a National Performance Measure of the Title V Maternal and Child Health Services Block Grant program.

Daw, Jamie R., Sarra Yekta, Faelan E. Jacobson-Davies, Stephen W. Patrick, and Lindsay K. Admon. “Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021.” JAMA Health Forum 4, no. 11 (November 22, 2023): e234179. https://doi.org/10.1001/jamahealthforum.2023.4179.

Kogan, Michael D., Paul W. Newacheck, Stephen J. Blumberg, Reem M. Ghandour, Gopal K. Singh, Bonnie B. Strickland, and Peter C. van Dyck. “Underinsurance among Children in the United States.” New England Journal of Medicine 363, no. 9 (August 25, 2010): 841–51. https://doi.org/10.1056/NEJMsa0909994.

Lavarreda, Shana Alex, E. Richard Brown, and Claudie Dandurand Bolduc. “Underinsurance in the United States: An Interaction of Costs to Consumers, Benefit Design, and Access to Care.” Annual Review of Public Health 32, no. 1 (March 18, 2011): 471–82. https://doi.org/10.1146/annurev.publhealth.012809.103655.

Musumeci, MaryBeth, Caitlin Murphy, Elizabeth Leiser, Hannah Silverman, and Kian Azimpoor. Reducing Medicaid Churn: Policies to Promote Stable Health Coverage and Access to Care. Issue Brief. Commonwealth Fund, June 2025. https://doi.org/10.26099/k808-3424.

Tikkanen, Roosa, and Melinda K. Abrams. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Issue Brief. Commonwealth Fund, January 2020. https://doi.org/10.26099/7avy-fc29.

Yu, Justin, James M. Perrin, Thomas Hagerman, and Amy J. Houtrow. “Underinsurance Among Children in the United States.” Pediatrics 149, no. 1 (January 1, 2022): e2021050353.https://doi.org/10.1542/peds.2021-050353.