The Annie E. Casey Foundation
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Pennsylvania

Statistics on children, youth and families in Pennsylvania from the Annie E. Casey Foundation and Pennsylvania Partnerships for Children

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Pennsylvania Partnerships for Children

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Children enrolled in publicly funded health care coverage in Pennsylvania

Children enrolled in publicly funded health care coverage

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Why This Indicator Matters

Children can receive publicly funded health care insurance through either Medicaid or the Children’s Health Insurance Program (CHIP).[1] Medicaid provides health insurance for millions of low-income children and covers a full range of medical services. [2] In Pennsylvania, children are eligible for Medicaid coverage if their household income falls within 157% (for ages 1 through 5) or 133% (for ages 6 through 19) of the federal poverty level.[3] Pennsylvania’s Medicaid program provides a complete health care package for children and includes the federally funded Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT), which offers regular checkups, and pays for medical services, treatments, and follow-up care for all eligible children.[4] Conversely, CHIP is a jointly-funded federal and state health insurance program for low-income children who cannot afford private coverage but have family incomes too high for Medicaid eligibility.[5] In Pennsylvania, CHIP benefits are available to all children and include doctor office visits; prescription drugs; dental, eye, and hearing care; diagnostic tests; emergency care; immunizations; and x-rays. A tiered system based on family income determines whether a child qualifies for free, low-cost, or full-cost CHIP, meaning some families will receive coverage at no cost at all while others will have low monthly premiums and co-pays.[6] Publicly-funded health care coverage is essential for low-income families because it ultimately plays a crucial role in their ability to live a productive, secure, and healthy life.[7] Research suggests that children covered by Medicaid and CHIP experience numerous positive long-term outcomes, including improved school performance, higher educational attainment, increased economic well-being and productivity, and greater lifetime earnings.[8], [9] Having health insurance coverage is also associated with better health-related outcomes, including chronic conditions, cancer, and life expectancy.[10]

[1] United States Census Bureau. (2022). Health Insurance Glossary. https://www.census.gov/topics/health/health-insurance/about/glossary.html

[2] Rudowitz. R., Williams, E., Hinton, E., & Garfield, R. (2021). Medicaid Financing: The Basics. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/

[3] Pennsylvania Health Law Project. (2020). Medical Assistance Eligibility Manual. https://www.phlp.org/uploads/attachments/ckbb0ll9k000jrhu8tzcvtvl1-ma-eligibility-manual-rev-2020.pdf

[4] Pennsylvania Department of Human Services. (2021). MA Services for Children. Medical Assistance Eligibility Handbook. http://services.dpw.state.pa.us/oimpolicymanuals/ma/309_Health_Care_Services_Benefits_for_Children/309_5_MA_Services_for_Children.htm

[5] Pennsylvania Department of Human Services. (2022). CHIP. https://www.dhs.pa.gov/CHIP/Pages/CHIP.aspx

[7] American Hospital Association. (2019). The Importance of Health Coverage. https://www.aha.org/system/files/media/file/2019/10/report-importance-of-health-coverage_1.pdf

[8] Paradise, J. (2014). The Impact of Children’s Health Insurance Program (CHIP): What Does the Research Tell Us? Kaiser Family Foundation. https://www.kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/

[9] Center on Budget and Policy Priorities. (2018). Medicaid Works for Children. https://www.cbpp.org/research/health/medicaid-works-for-children

[10] Bovbjerg, R.R. & Hadley, J. (2007). Why Health Insurance is Important. The Urban Institute, Healthy Policy Briefs. https://www.urban.org/sites/default/files/publication/46826/411569-Why-Health-Insurance-Is-Important.PDF

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Definition and Source

PROVIDER

Definition

The number and percent of children enrolled in Medicaid (also referred to as Medical Assistance, or MA) and CHIP.

Data Source

PPC's State of Children's Health reports & source documentation can be found at https://www.papartnerships.org/resources-publications/reports/#health-care.

Notes

The totals are greater than the sum of ages birth to 5 and 6 to 18 subcategories due to report timing differences and the exclusion of 19-year-olds in the CHIP data.

The year represents when the PPC or HEDIS reports were published.

Last Updated

January 2024