While the uninsurance rate for adults has risen in recent years, the opposite is true for children: fewer and fewer children are going without health care coverage. This steady decline in uninsured children is due in part to the fact that children’s public insurance programs—Medicaid and the Children’s Health Insurance Program (CHIP)—have become stronger and more accessible at a time when children and families need them most. And much of the credit for the recent strengthening of these programs belongs to the Children’s Health Insurance Program Reauthorization Act (CHIPRA), signed into law by President Obama exactly two years ago today. Happy second anniversary, CHIPRA!

CHIPRA provides states with incentives (in the form of bonus payments) to enact enrollment and retention simplification measures to improve coverage rates, offers grants for conducting innovative outreach, enrollment and quality-improvement activities. It also authorizes new policy options like Express Lane Eligibility, coverage of pregnant women in CHIP, and removal of the five-year waiting period for lawfully residing immigrant children and pregnant women to enroll in public insurance.

All of these new financial resources and policy options have enabled states to make significant improvements to their children’s health programs in a very short amount of time. In 2010 alone, 13 states expanded eligibility, 14 states made improvements in enrollment and renewal procedures, and 15 states qualified for bonus payments. Nationwide, Medicaid and CHIP programs for children are more comprehensive and efficient than ever. According to the recently-released 2010 CHIPRA Annual Report:

— 46 states and the District of Columbia now cover children with incomes up to 200 percent of the Federal Poverty Level (FPL) ($44,700 for a family of four). — 22 states now offer coverage to lawfully residing immigrant children and/or pregnant women. — 48 states and the District of Columbia have a 12 month eligibility period for Medicaid and CHIP and 23 states offer 12 months of continuous eligibility. — 32 states have an on-line application that can be submitted electronically and 29 states allow electronic signatures on applications. — 33 states and the District of Columbia are utilizing the data matching process provided by the Social Security Administration to confirm U.S. citizenship for children in Medicaid.

Thanks in part to these program enhancements and eligibility improvements, over two million children gained Medicaid or CHIP coverage during federal fiscal year 2010, with the programs serving more than 42 million children during this timeframe. These numbers should continue to rise in the years to come, as outreach, enrollment and retention efforts ramp up thanks to a new round of outreach and enrollment grants and U.S. Department of Health and Human Services Secretary Kathleen Sebelius’ Connecting Kids to Coverage Challenge, which aims to enroll five million eligible but uninsured children in Medicaid and CHIP by 2015.

Yet there is a chance that coverage for children will not continue to move in the right direction. If Republican governors get their way and states no longer have to comply with the Affordable Care Act’s Maintenance of Effort (MoE) requirement, coverage for millions of children in CHIP and optional Medicaid expansions could be eliminated. States could also impose “back door” cuts by using red tape barriers to make it harder for children to sign up for coverage. For example, programs could reinstate face-to-face interviews or shorten eligibility periods.

We cannot afford to let this happen. We need strong Medicaid and CHIP programs to create a solid foundation for the full implementation of the Affordable Care Act in 2014 and to ensure that our nation’s children have the coverage they need to stay healthy. Eliminating the MoE requirement would be a penny-wise and pound-foolish way to address budget shortfalls. After all, let’s not forget about what’s at stake here: the health and well-being of our nation’s children.

—Maia Fedyszyn, Program Associate New England Alliance for Children’s Health