New report shows Oklahoma led nation in improving health insurance coverage, but more than 75,000 Oklahoma children remain uninsured

The rate of Oklahoma children without health care insurance decreased significantly – from 8.6 percent to 7.4 percent between 2019 and 2021, according to a new report from the Georgetown Center for Children and Families. This marked the nation’s largest improvement during that time period, and it represents about 11,000 more Oklahoma children who gained health insurance. This improvement is primarily due to Oklahoma’s implementation of Medicaid expansion and the federal continuous enrollment requirement that has been in place since January 2020.

Though Oklahoma has seen a significant decline in its child uninsured rate, work remains to address the needs for 75,000 Oklahoma children who remain without health care insurance. Additionally, nearly 100,000 Oklahoma children who are currently insured by Medicaid may be at risk of losing coverage when pandemic Medicaid provisions lapse due to changes in eligibility or administrative issues such as outdated contact information.

To continue ensuring the health of our youngest Oklahomans, state elected officials and policymakers must enact policy solutions available that would protect the significant coverage gains of the last few years. These solutions include implementing 12 months of continuous coverage for children and ensuring Oklahoma’s Medicaid eligibility for children more closely matches eligibility in other states.

Improvements in Oklahoma’s child uninsured rate are primarily due to Medicaid expansion and the public health emergency’s continuous coverage requirement. 

SoonerCare, the state’s Medicaid program, is the largest source of children’s health insurance in Oklahoma with 46.6 percent of children insured by Medicaid in 2021. The improvements to Medicaid in the last few years have significantly impacted the lives of Oklahoma children.

Medicaid expansion was implemented in July 2021, and more than 333,000 adult Oklahomans have enrolled in that coverage, as of October 2022. Expansion appears to have had a “welcome mat” effect for Oklahoma children; as parents newly gained insurance through Medicaid, they were more likely to enroll eligible children in Medicaid as well. Prior to the implementation of Medicaid expansion, parents may not have known their children were eligible, potentially due to confusing eligibility rules. The coverage expansion for adults – along with significant outreach efforts by the Oklahoma Health Care Authority and community organizations – led to more children being enrolled and insured, as well.

The other factor that has contributed to the decrease in child uninsurance is the public health emergency’s continuous enrollment requirement. In January 2020, the federal government declared a public health emergency in response to the COVID-19 pandemic and began requiring that states keep the majority of Medicaid enrollees enrolled in the program – regardless of eligibility changes – in exchange for greater federal funding. The federal public health emergency is still in effect and, as of this writing, is expected to continue until at least April 2023. The continuous enrollment requirement has ensured that Medicaid enrollees can continue to access life-saving health insurance throughout the pandemic and resulting economic instability.

While it’s difficult to identify the discrete impacts of Medicaid expansion and the public health emergency, it is clear that both have had an impact: in October 2022, nearly 700,000 Oklahoma children were insured by Medicaid, compared to 520,000 in January 2020. Taken together, these policy choices have increased the prevalence of health care coverage for Oklahoma’s children. The end result is that more children can see their doctors and access important preventive health care.

Moving forward, Oklahoma must protect and build on these coverage gains. 

In order to maintain the improvements in insurance rates, Oklahoma should implement 12 months of continuous coverage for all children insured by Medicaid after the public health emergency ends. This would bring Oklahoma in line with the majority of other states, as 34 states provide continuous coverage for some or all of their children enrolled in Medicaid. Continuous coverage ensures that children are enrolled in Medicaid for a full year, regardless of any eligibility changes, such as income fluctuations or the failure to meet an administrative requirement. This provision is especially meaningful for children because they have no control over income changes or whether their parents fulfill administrative requirements. Continuous coverage has several benefits to the state, including increasing access to care, improving health outcomes, and driving more efficient health care spending.

The state should also consider increasing the Medicaid income eligibility limit for children. In Oklahoma, children qualify for Medicaid if their family income is less than 205 percent of the federal poverty line (FPL) – or $48,384 annually for a three-person household. In many other states, children qualify for some level of Medicaid coverage up to much higher income levels, including 312 percent of the FPL in Alabama and 400 percent of the FPL in New York, and an average of 256 percent of the FPL across all states. Covering more children through Medicaid would be a step towards ensuring all Oklahoma children have access to insurance.

Let’s prioritize high-quality, affordable health insurance for all children.

The findings from the new Georgetown Center for Children and Families demonstrate that smart policy decisions can help kickstart advancements in the health and well-being of Oklahomans. When taken together, Oklahoma’s implementation of Medicaid expansion and the provisions of the federal public health emergency significantly decreased the child uninsured rate in Oklahoma. The gains we have made are laudable, but any celebration should be tempered as we must focus on the 75,000 Oklahoma children who remain uninsured. To protect these coverage gains and build on this momentum, our state’s elected officials and policymakers should implement 12 months of continuous eligibility for all children and increase the income levels at which children can qualify for SoonerCare. Doing so would increase access to health care coverage. This would mean more children could proactively see their doctors, get immunizations, undergo screenings for developmental delays, and treat health issues as they arise. The investments we make today in expanding and strengthening access to Medicaid will help protect the well-being of our state’s future — our children.

ABOUT THE OKLAHOMA POLICY INSTITUTE

The Oklahoma Policy Institute focuses on nonpartisan policy research, analysis, and advocacy to ensure all Oklahomans can be healthy, live in safe communities, and raise thriving families.

ABOUT THE GEORGETOWN CENTER FOR CHILDREN AND FAMILIES

The Center for Children and Families is a nonpartisan policy and research center based at Georgetown University McCourt School of Public Policy.

ABOUT THE AUTHOR

Emma Morris joined Oklahoma Policy Institute as the Health Care and Revenue Policy Analyst in April 2021, and she previously worked as an OK Policy intern and as the Health Care Policy Fellow. She has worked as a case manager with justice-involved individuals and volunteered as a mentor for youth in her community. Emma holds dual bachelor’s degrees in Women’s and Gender Studies and Public and Nonprofit Administration from the University of Oklahoma, and is currently working on a Master of Public Administration degree from OU-Tulsa. She is an alumna of OK Policy’s 2019 Summer Policy Institute and The Mine, a social entrepreneurship fellowship.

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