The 2020 Census is make-or-break for children’s healthHealth
The coronavirus crisis has canceled or postponed thousands of events worldwide, but one major event is still on track: The 2020 United States Census. Every ten years, the United States sets out to count each and every person living in the country. Knowing how many of us there are informs our national identity and provides data to effectively design and fund life-saving programs across the country. Medicaid and the Children’s Health Insurance Program (CHIP) are two of the most important.
Between them, these two programs offer health care coverage 46 million children over the course of a year. They provide coverage to kids in low-income families or whose working parents lack affordable employer-sponsored coverage. Medicaid is the largest insurer of children in the country and nearly 50% of its recipients are kids. In 2018, CHIP covered almost ten million children, along with several hundred thousand pregnant women.
For these programs, the Census is make-or-break. Why? Federal funding for Medicaid and CHIP is based on a formula known as the Federal Medical Assistance Percentage (FMAP), which is determined in part by a state’s population. The higher the population, the fewer dollars the FMAP requires states to contribute from their own budgets. When the Census undercounts the population – and children under the age of five are the most likely to be missed – states lose billions of dollars in federal funding.
As co-leader of the Count All Kids campaign, First Focus on Children is working to make sure that the 2020 Census captures those hard-to-reach children and families, ensuring that Medicaid and CHIP receive their fair share of federal dollars.
Under the state-federal partnership that funds Medicaid and CHIP, the federal government covers at least 50% of program costs. The states contribute the balance. The federal government, however, can provide as much as 83% of the funding, with the state partner contributing just 17%. The FMAP determines what percentage a state must contribute.
The FMAP is based on a state’s per capita income. The U.S. Bureau of Economic Analysis calculates per capita income by dividing the aggregate income of all state residents by the state’s total population as determined by the census. When the census undercounts residents, the state’s per capita income is calculated as inaccurately high. The higher the state’s per capita income, the higher its required contribution according to the FMAP. In fiscal year 2015, the loss of federal dollars per person missed by the 2010 Census ranged from $533 for Utah to $2,309 for Vermont.
Over the course of a year, Medicaid covers around 36 million children; CHIP covers close to 10 million. These programs are especially critical for kids in times of economic crisis like the one created by COVID-19. When unemployment rises, families lose employer-sponsored health care coverage along with their jobs. During the 2008 recession, every 1% increase in the unemployment rate meant an additional 600,000 children became eligible for Medicaid and CHIP.
Medicaid and CHIP also serve as primary sources of coverage for many children of color. Together, the programs cover almost one-third of White (31%) children, one-quarter of Asian (28%) children, and more than half of Hispanic (56%) and Black children (58%), who are more likely to live in low-income families than White children.
Ensuring that Medicaid and CHIP are fully funded means better health care access and health outcomes for children. To make sure states receive their rightful share of federal financing through the 2020s, all people need to be counted. Undercounts in states create under-funding and stretched programs that can’t meet the needs of all eligible children.