Group Title: Florida Health Insurance Study fact sheets
Title: Health insurance coverage among children in Florida
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 Material Information
Title: Health insurance coverage among children in Florida
Series Title: Florida Health Insurance Study fact sheets
Physical Description: Serial
Language: English
Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: August 2005
 Record Information
Bibliographic ID: UF00091096
Volume ID: VID00002
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.


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Florida Health Insurance Study

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Health Insurance Coverage Among Children in Florida

Children are particularly vulnerable to the effects of uninsurance. Frequent
and timely well-child checkups, immunizations, and developmental
assessments are considered critical in assuring healthy growth in children.
Uninsured children are much less likely to receive such care, which could
perhaps lead to lifelong health problems. This fact sheet examines health
insurance coverage among Florida's children by comparing findings from the
1999 and 2004 Florida Health Insurance Surveys.

Rates of Uninsurance, 1999 vs. 2004
Figure 1
illustrates U C
that while U Children 0 Adults
adult 25%
rates 20% 18.5% 19.6%
from 2000 to
2002 nation- 15% 12.3% 12.1% 12.0%
wide, rates
for children lo% -
held relatively
steady. 6%
However, a
number of o0%
children 2000 2001 2002
under age 19 Source Kaiser Family Foundation, Kaiser Commission Key Facts, December2003
continue to lack health insurance coverage.

Prior to 1998, Medicaid was the sole major source of public health insurance
coverage for children. In order to create a health care safety net for children
living in low- to moderate-income Florida families, the legislature enacted
the Florida KidCare Program in 1998. The program was designed to provide
comprehensive health coverage for previously uninsured children, using
combined federal and state resources from Medicaid (Title XIX of the Social
Security Act) and the State Children's Health Insurance Program, also
known as SCHIP (Title XXI of the Social Security Act). The Florida KidCare
Program is an "umbrella" service delivery system comprised of four distinct
components: MediKids, Florida Healthy Kids, Children's Medical Services,
and Medicaid for Children.

With the successful implementation of the KidCare Program, the uninsurance
rates for Florida's children decreased almost two percentage points, from
13.9% in 1999 to 12.1% in 2004 (Figure 2).

Most of the overall decline in uninsurance
occurred among preschoolers and infants
(aged 0 to 4 years). The rate of uninsurance I 1999 0 2004
for this age group decreased markedly, from 16%- 14.8%
11.9% in 1999 to 8.1% in 2004. % 13.9% 141%
12.1% 11.9% 12.7% 12.4%
Among older children, however, changes in 12%
levels of uninsurance mirrored nationwide 10%
levels and remained relatively flat (12.4% vs. 8.1%
12.7% for children 5 to 9 years, and 14.1% vs.
14.8% for children 10 to 18 years old). 6%
Variation in Uninsurance
by Income Level 2%
Rates of uninsurance in children vary according
to o s ld in ce ind g ro e Total 0 -18 years 0 4 years 5 9 years 10 -18 years
to household income. Findings from the
2004 survey indicate that for children overall, Source: 1999 and 2004 Florida Health Insurance Studies (FHIS)
uninsurance rates declined as family household
income increased (Table 1). For example, among households with annual earnings at 100% or less of
the Federal Poverty Level (FPL), 21.6% of children were without coverage. In comparison, only 5.7% of
children were uninsured in households with income levels above 200% of FPL (In 2004, a family of four was
considered to be at 200% of FPL if annual household income equaled $37,700).

Overall, approximately half a U C
million children in Florida were P
without coverage in 2004.
Although many of the uninsured
children live at 100% or less
of FPL, a quarter of Florida's
uninsured children live in 100% FPL or less 21.6 8.6 12.5 25.9 170,000
families with incomes greater
than 200% of FPL. 100-133% FPL 20.0 2.3 15.7 22.6 69,000

Racial and Ethnic 134-185% FPL 17.9 14.7 14.0 19.4 109,000
Differences in
Uninsurance Rates 186-200% FPL 16.5 4.5 15.1 17.6 26,000
Although rates of uninsurance
are lower for children than
Greater than 200% FPL 5.7 5.9 3.8 6.4 128,000
adults, the pattern of children's
uninsurance based on racial
All Income Levels 12.1 7.6 8.5 13.7 504,000
and ethnic characteristics
parallels that of adults. Figure
3 shows the proportion of Numbers may not sum to a meaningful total due to rounding effects
uninsured children by race/ Source: 2004 Florida Health Insurance Study (FHIS)
ethnicity and age groups. Overall, Hispanic children had the highest rates of uninsurance in 2004, followed
by Black children. Relative to Non-Hispanic Whites, Hispanic children were twice as likely to lack health
insurance coverage (17.4% vs. 8.5%).

Although rates of uninsurance increased with age among all racial/ethnic groups, this trend was particularly
evident for Hispanic children. Across all age groups, older Hispanic children (age 10 tol8 years) have the
highest rate of uninsurance (22.6%), while Non-Hispanic White and Black preschoolers and toddlers (ages 0-
4) have the lowest levels of uninsurance (7.5% and 7.4% respectively).


page 2

Insurance Status and Source of Coverage F i .. ...R ...
Figure 4 highlights changes in source of coverage . -
between 1999 and 2004. Perhaps most noteworthy is Non-HispanicWhite Hispanic Black
the 10 percentage-point decline in rates of employer- 25/- 22.6%
sponsored health insurance coverage from 58.4% in 20%. 19.1%
1999 to 48.5% in 2004. The erosion in employer- 17.4% 17.0%
sponsored coverage mirrors national trends and may be % 13.8%
reflective of higher premiums, copays, and deductibles 12.7
being charged to employees, as well as a reduction in the 10% 8.5% . 1 0 9.5%0
number of firms offering coverage to workers and their % 7.4% 8.4%
families. 5%o

Some of the decline in rates of employment-based 0%
insurance coverage appears to be offset by increases TotalAge 0-18 Age0-4 Age 5-9 Age 10-18
in private and public coverage. The rate of individually Source 2004 Forida Health Insurance Study (FHIS)
purchased coverage increased during the five-year
period from 8.4% in 1999 to 11.1% in 2004. 1 01999 02004
Similarly, over the five-year period, participation in 60% -584%
publicly funded programs increased dramatically (from 48.5%
17.2% in 1999 to 30.8% by 2004).
Other government programs, including Children's Medical 30% 30.8%
Services and Medicare (covering disabled children and ^
those with end-stage renal disease) doubled participation 2 13.9., 12.1",,
rates, increasing from 1.5% in 1999 to 2.9% in 2004. 10% 8. 4.0", 2.9" 1.5,
It should be noted that coverage source is not mutually Employment Private, Indiv. Military, Medicaid and Other Uninsured
Based Purchased CHAMPUS, Title XXI Government
exclusive, since families with access to private or VA Programs Programs
Sr Source 1999 and 2004 Florida Health Insurance Studies (FHIS)
employment-based family coverage may also have a
publicly subsidized option.

Reducing the Number of Uninsured Children 60%
The public health insurance system serves as a 50% 49.6%
mechanism to reduce rates of uninsurance among
children. As Figure 5 illustrates, almost 50% of 40% -
uninsured children had been enrolled in Medicaid at 30% 27.3%
some point in their lives. This suggests that state 22.2%
interventions, such as simplifying enrollment processes, 20% -
expanding eligibility levels and continued parent 10% O
education may encourage longer periods of enrollment in
Medicaid and SCHIP. 0%
Under 65 Children (Under age 19) Adults (Age 19-64)
Sum m ary Source. 2004 Florida Health Insurance Study (FHIS)
The overall rate of uninsurance among children in Florida has declined in the last 5 years, from 13.9% in 1999 to
12.1% in 2004. While this reduction is clearly positive, it is noteworthy that a large number of children in Florida
- over a half million are still without health insurance. Uninsurance in children has long-term implications for the
state, since inadequate health screenings and developmental assessments may result in lifelong health problems.

Uninsurance rates vary by socioeconomic and demographic characteristics. Particularly high rates of uninsurance
are found among Hispanic children, children of very low-income families, and children between ages 10 to 18.

Employer-sponsored insurance, which covers over half of Florida children under 19, declined notably during
the five-year period. This decline mirrors national trends. However, some of the decline in rates of employer-
sponsored coverage in children is offset by their increased participation in Medicaid and Title XXI programs.

Florida Center for Medicaid and the Uninsured

page 3

Florida Health Insurance Study

PO BOX 100227

Florida Center for Medicaid and the Uninsured
Shaping Healthcare Policy

Data Source and Methods
The findings presented in this fact sheet are based on data
from the 2004 Florida Health Insurance Study. Telephone
interviews were conducted between April and August of 2004
with 17,435 Florida households, collecting data on
approximately 46,876 individuals under age 65. Telephone
fieldwork was conducted by the Survey Research Center of
the University of Florida's Bureau of Economic and Business
Research. Up to 20 phone calls were made to each household
selected by random-digit dialing. Interviews were conducted in
English, Spanish, or Haitian Creole, at the discretion of the
interviewee. Each interview took approximately 14 minutes to
complete, depending on the size of the household. A full
household enumeration was implemented, and information
was also obtained about health status, access and utilization
of health services, and type of employment. Survey
methodology details are available at
The 2004 Florida Health Insurance Study was funded by the
State Planning Grant (SPG) program of the Health Resources
and Services Administration (HRSA, Grant Number 1-P090
A016 80-01-00), with state level management from Florida's
Agency for Health Care Administration (AHCA), and survey
work conducted by a team from the University of Florida's,
College of Public Health and Health Professions.



STATISTICIAN: Cynthia Wilson Garvan
INVESTIGATOR: Christy Harris Lemak
Lorna P. Chorba

PRINCIPAL: Marshall E. Kelley

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