Coverage doesn't equal access for children

Nearly half of children in DC are covered by Medicaid and the Children's Health Insurance Program, which provides health insurance to children from low-income families who do not qualify for Medicaid. This is a good thing, because it means that low-income children have health insurance. But unfortunately, being covered by Medicaid doesn't mean that children have access to treatment when they need it.

A study in Illinois demonstrated how hard it can be to get an appointment when you’re covered by Medicaid—the waiting time for children with Medicaid was 22 days longer than those using private insurance, even for children with serious medical problems.  That’s nearly a month of waiting time for treatment!

The problem is particularly acute for mental health concerns, a legislative priority for the District. National data estimate that 13.5% of low-income children need mental health treatment. Yet D.C’s Medicaid program provided outpatient or community-based mental health treatment to only six percent of its child beneficiaries in FY2010. Thus, over 7,000 children who were covered by insurance did not get the services they need.

What’s to blame? Doctors aren’t being paid on time and Medicaid payments are lower, so many would rather take privately insured patients or not take Medicaid at all.

Hopefully we’ll see some improvement on that last count here in the District, at least over the next year. Last week, the D.C. Council approved an additional $32 million in funding to Medicaid providers. It remains to be seen whether this boost will result in increased access for children.

While this may address some of D.C. Medicaid’s current issues, the future of Medicaid is far from certain, as we blogged about earlier.  Facing large budget constraints, states across the map are cutting Medicaid costs on their own and asking for the authority to cut more. Meanwhile, Congress is talking about completely overhauling the structure of Medicaid, giving states more authority to dictate eligibility and benefits, which would undoubtedly end with fewer children getting the health care they need. 

We'll keep following the issue to see how it may affect D.C.'s children. In the meantime, if you have information or a perspective you'd like to share, please email me at