Addressing Underinsurance for Children With Special Health Care Needs

Underinsurance among children and adolescents is a worsening problem in the United States.In 2010, an estimated 19% of US children were underinsured, representing 14 million children.However, a recent study estimated the underinsured proportion of children at 33% or approximately 24 million in 2019. 1,2ildren are considered underinsured when, despite having health insurance coverage, they or their families experience prohibitive out-of-pocket costs, narrow networks of physicians, other clinicians, and hospitals that limit access, or challenges with enrollment and churn.These challenges can affect children with public and commercial insurance coverage.For example, the current unwinding of public insurance coverage from continuous enrollment provisions during the COVID-19 pandemic has led to more than 1.5 million children being procedurally disenrolled from Medicaid, and they must then re-enroll in their states' programs to reestablish coverage.Churning off and on insurance contributes to underinsurance because families may forgo care while awaiting re-enrollment.Rising outof-pocket costs have been reported among children with commercial plans, especially highdeductible health plans (HDHPs).These HDHPs can lead families to have their children go without prescription medications that have high out-of-pocket costs.