Question: I've heard there are some problems with subsidies for child-only coverage under ACA. Can you explain what these children and their families face, and what can be done to address these issues?
Answer: Employer-sponsored health insurance often does not cover dependents. In other instances, families find that the dependent coverage that is offered is unaffordable. Consequently, some children whose parents have group health coverage must rely on other sources of coverage, including Medi-Cal, CHIP or individual health insurance. Eligibility for premium subsidies under the ACA is limited for those without employer-sponsored health insurance, which may create challenges for parents wishing to purchase coverage for their children in the exchange. Clarification on how such subsidies will be determined is necessary.
Within-family variations in eligibility can complicate matters. Because of different income eligibility thresholds for adults vs. children, many children are eligible for
Medi-Cal or CHIP while their parents are not. Eligibility is also dependent on citizenship and documentation status, and variation in status among parents and children is not
uncommon. Citizen children of undocumented parents, for example, may be eligible for Medi-Cal while their parents are not. Under the ACA, some children will qualify for Medi-Cal or CHIP while their parents may qualify for premium subsidies to purchase coverage in the exchanges. Families in these situations may need special outreach to ensure they are aware of options for children, and integration of eligibility and enrollment processes for Medi-Cal, CHIP and exchange coverage will also be important.
Additional complexities are introduced when one parent is living outside the household, or when children live with grandparents, other relatives, guardians or in foster care. Today, parents living separately often share responsibility for obtaining their children's coverage, sometimes as a result of a court order, which can create many complexities. Issues also arise for children living in kinship care with neither parent - often
with grandparents who receive Medicare benefits, or with relatives who receive ESI, but for which the children do not qualify. Child support orders will need to evolve to
be consistent with new coverage requirements under the ACA, and options for child-only policies and associated subsidies will also require clarification.
Going forward, it will be important to consider how the law will apply to children living in these situations, and what special considerations for them may be warranted as the new regulations are developed and implemented. For more information, read the full report funded by the Robert Wood Johnson Foundation and prepared by researchers at the Urban Institute.