All children deserve access to quality health care. Public policy should ensure that children benefit from both preventive health care and the dramatic advances in American medical care. Extensive research has documented both short- and long-term positive effects of health care for children. Children who can access Medicaid and CHIP for longer periods are less likely to drop out of high school and more likely to complete college. They are more likely to earn higher incomes and contribute more in taxes. As adults, they are less likely to be hospitalized, have high blood pressure or die prematurely.[1] In addition, their parents have reduced out-of-pocket expenses and thus more money for rent, food and utilities.[2] However, children who do not have access to comprehensive health care will not have these advantages, and without affordable health care, a child’s serious illness can quickly bankrupt families and further reduce their chances of success.

Policy | Automatic Medicaid Enrollment for All Children at Birth

Background on Policy

As illustrated by the graph below, 39 percent of all children in the United States received their health insurance through the Medicaid and CHIP programs in 2019. These programs cover 44 percent of children with special health care needs and 79 percent of children in or near poverty. States that expanded Medicaid as part of the ACA show decreased infant and maternal mortality.[3] However, four million children remain uninsured, and data show that we are losing ground for the first time in many years.[4], [5], [6]

Where Medicaid Fits In

At the end of 2018, there was a 2.2 percent decline in the number of children enrolled in Medicaid and CHIP from the same time in 2017, which means over 800,000 children that were covered under Medicaid or CHIP at the end of 2017 were not covered by those programs at the end of 2018. This change is illustrated in the two graphs below. While some of these children may have transitioned to employer-sponsored coverage with their parents, many have lost access due to the previous Administration’s attacks on the program.[7] In order to prevent a lapse in coverage for children, every child must be eligible for Medicaid. Losing ground on health care for children after years of progress is a moral blot on our Nation that undermines our national security.


Policy Description

This proposal would make all children through age 18 eligible for coverage under Medicaid. Children would be automatically enrolled at birth and would retain that eligibility until the age of 18, with no redetermination requirement. Parents could proactively opt their child out of Medicaid if they had another form of coverage, such as being eligible for CHIP, securing coverage through the marketplace or having coverage through their parent's employer. The federal government would cover the cost of this Medicaid population with a 100 percent Federal Medical Assistance Percentage. CHIP is currently authorized through FY 2027, and the existing maintenance-of-effort requirement would keep CHIP as an option for families with incomes up to 300 percent of the federal poverty level who prefer CHIP to the new Medicaid benefit. This proposal assumes that CHIP continues to provide children with coverage beyond the current authorization.

Expected Impact of Policy

By guaranteeing that every child from birth through age 18 has access to health care under the Medicaid program, we increase the likelihood that they will receive the well visits and early interventions that they need to develop and grow. Together, Medicaid and CHIP cover more than 35 million[8] of the approximately 73 million children in the country.[9] Children enrolled in Medicaid have access to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, which is the standard of pediatric care recommended by the American Academy of Pediatrics.[10] EPSDT ensures that children have access to preventive care and early intervention when problems are discovered and is often more comprehensive that what is offered in commercial plans. As studies have shown,[11], [12] access to Medicaid, and especially to EPSDT, leads to positive education and economic outcomes over an individual’s lifetime. By guaranteeing access to health care, this policy will create a better future for our children and our Nation.

[1] “October 2019 Medicaid & CHIP Enrollment Data Highlights.” January 10, 2020,,

[2] American Community Survey, “Population Under 18 Years by Age,” (United States Census Bureau, 2018),|estimate.

[3] Margaret McManus, Bright Futures and EPSDT: A National Review (American Academy of Pediatrics, August 2018),

[4] Dee Mahan, Medicaid’s Children’s Benefit—EPSDT—Supports the Unique Needs and Healthy Development of Children (Families USA, November 2018),

[5] Medicaid Works for Children (Center on Budget and Policy Priorities, January 2018),

[1] Tricia Brooks, “New Data Show Widespread Decline in Child Enrollment in Medicaid/CHIP Coverage in 2018,” June 6, 2019, Georgetown University Center on Children and Families,

[1] Donna Cohen Ross et al, Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies (Georgetown University Center on Children and Families, 2017),

[2] Joan Alker et al., Nation’s Progress on Children's Health Coverage Reverses Course (Georgetown University Center on Children and Families, 2018),

[3] Elizabeth Chuck, “‘Kids are falling off’: Why fewer children have health insurance now,” NBC News, December 8, 2019,

[4] Edward R. Berchick and Laryssa Mykyta, “Children’s Public Health Insurance Coverage Lower Than in 2017,” September 10, 2019, United States Census Bureau,

[1] Medicaid Works for Children (Center on Budget and Policy Priorities, January 29, 2018),

[2] National Academies of Sciences, Engineering, and Medicine, A Roadmap to Reducing Child Poverty (The National Academies Press, 2019),