The State of America's Children® 2020

Notes: Uninsured is defined as not covered by any type of insurance (private or public) for the entire year. The White racial category does not include children of Hispanic ethnicity.

Source: Berchick, Edward, Jessica Barnett and Rachel Upton. 2019. “Health Insurance Coverage in the United States: 2018 Current Population Reports.” U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf.

a Uninsured at the time of the survey, not necessarily for the entire year. These numbers are among children ages 0-18.

b Calculations were based on a comparison with data from 2017 American Community Survey 1-Year Estimates, Table S2701- Selected Characteristics of Health Insurance Coverage.

c States are ranked 1-50 with 1 meaning the highest percent of children who are uninsured and 50 meaning the lowest percent of children who are uninsured.

d These states had expanded Medicaid to 138 percent of the FPL for all eligible adults in the state as of January 2019. An asterisk (*) denotes the state has expanded Medicaid between January 2019 and January 2020. When parents are covered, their children are more likely to also be covered.

Note: Uninsured numbers and percents in this table cannot be directly compared to those from the Current Population Survey (CPS) as they come from different surveys.

Sources: U.S. Census Bureau. 2019. 2018 American Community Survey 1-Year Estimates, Table B27001 – Health Insurance Coverage Status by Sex by Age. https://data.census.gov/cedsci/; Brooks, Tricia, Edwin Park and Lauren Roygardner. 2019. “Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again.” Appendix Table 1. Georgetown University Health Policy Institute Center for Children and Families. https://ccf.georgetown.edu/wp-content/uploads/2019/06/Enrollment-Decline.pdf; Kaiser Family Foundation. 2020. “Status of State Action on the Medicaid Expansion Decision, as of January 10, 2020. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

a Highest level of income eligibility for Medicaid or CHIP as a percent of the federal poverty level (FPL).

b “Waiting period” refers to the length of time a state requires a child to be uninsured prior to enrolling in CHIP, although every state has exceptions. The ACA prohibited waiting periods longer than 90 days starting in 2014.

c “M” denotes 12-month continuous eligibility for Medicaid. “C” denotes 12-month continuous eligibility for CHIP. “n/a” denotes the state does not provide a separate CHIP program for uninsured children.

d These states cover immigrant children who have been lawfully residing in the U.S. for less than five years under the Immigrant Children’s Health Improvement Act (ICHIA) option with state funds.

e These states have expanded Medicaid to 138 percent of the FPL for all eligible adults in the state as of January 2020. When parents are covered, their children are more likely to also be covered.

Sources: Brooks, Tricia, Lauren Roygardner and Samantha Artiga. 2019. “Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Practices as of January 2019: Findings from a 50-State Survey.” Georgetown University Center for Children and Families and Kaiser Family Foundation. https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey/; Kaiser Family Foundation. 2020. “Status of State Action on the Medicaid Expansion Decision, as of January 10, 2020. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

Notes: Infant mortality is defined as death before age 1. Race/ethnicity is based on the infant’s race/ethnicity. White and Black racial categories exclude infants of Hispanic ethnicity. Hispanic infants can be of any race. Data for other racial/ethnic groups were not available. “n/a” means data reported by state did not meet standard of reliability or precision according to the Center for Disease Control and Prevention.

Sources: Markus, Anne Rossier et al. 2013. “Medicaid Covered Births, 2008-2010, in the Context of the implementation of Health Reform.” Women’s Health Issues Journal 23-5; The Centers for Disease Control and Prevention. 2019. “Deaths: Final Data for 2017.” Table 15. National Vital Statistics Report 68 (9). https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf; United Health Foundation, America’s Health Rankings. 2019. “National Maternal Mortality.” CDC Wonder Online Database, 2013-2017. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality_a/state/ALL.