Underinsurance
While the vast majority (96%) of families raising CYSHCN report that their children are insured, health insurance coverage does not guarantee access to needed care. According to the 2020-2021 National Survey of Children’s Health, 32.7% of CYSHCN lacked adequate insurance, also called underinsurance. The survey defines adequate insurance as coverage that 1) offers benefits or covers services that meet the child’s needs, 2) allows them to see the providers they need, and 3) has reasonable out of pocket costs. One option states have to reduce underinsurance among CYSHCN is to adopt the Family Opportunity Act to expand Medicaid coverage to Supplemental Security Income (SSI) eligible children whose families have incomes up to 300% of the Federal Poverty Level. State Title V agencies are often interested in increasing access to adequate insurance for CYSHCN to improve health outcomes, increase access to care, and reduce family financial hardship.
Strategies for Title V Programs to Reduce Underinsurance 
Indiana’s CYSHCN program provides grant funding and conducts programming focused on insurance access for both those who are uninsured and those who are underinsured. Title V partners with organizations including Indiana Family to Family and Covering Kids and Families of Indiana.
Oklahoma’s Title V program works with a Medicaid staff member who manages the TEFRA program to help families navigate their coverage. When families are dually enrolled in Medicaid and private insurance, this staff member is able to assist them in determining what will be covered by Medicaid after their private insurance coverage to reduce out-of-pocket costs.
North Carolina uses Title V funds to support Child Health Services in local health departments for CYSHCN who are uninsured or underinsured. The Title V agency reimburses health departments for well or sick visits for uninsured children from birth to age 21. Eligibility criteria for receiving care at local health departments vary by county.
During the COVID-19 pandemic, Colorado opened a special enrollment period for individuals to enroll in health insurance plans that met minimum essential coverage standards if their current plan did not meet those standards. This special enrollment period allowed more than 14,000 people to enroll in minimum essential coverage plans.