MCH Update 2001: Trends in State Health Insurance Coverage of Pregnant Women, Children, and Parents

Since 1990, the NGA Center has reported on the status of state Medicaid coverage of children and pregnant women and innovative maternal and child health initiatives. This has served as the definitive report documenting changes in Medicaid eligibility to pregnant women, infants, and children across the nation.



The State Children’s Health Insurance Program (SCHIP) and Medicaid are two of the largest providers of health insurance and health coverage to low-income pregnant women, children, and parents. In fiscal 2001, SCHIP covered more than 4.6 million children and Medicaid covered more than 20 million children. In 1999 (the latest year of data), Medicaid paid for more than one-third of births in the states.

States are exploring options to extend health coverage to the parents of children covered by Medicaid and SCHIP. These options include:

  • Medicaid Section 1115 Research and Demonstration Waivers. States may use Medicaid 1115 waivers to develop research and demonstration programs with Medicaid matching funds that cover more populations and services than the state would ordinarily be able to cover under a traditional Medicaid program.
  • Medicaid Section 1931. Medicaid Section 1931 allows states to provide Medicaid coverage to lowincome parents who meet certain income thresholds.
  • SCHIP Family Coverage. States can cover parents of SCHIP-eligible children through a SCHIP 1115 waiver, which is similar to a Medicaid 1115 waiver, or they may use employer buy-in programs that access employer-sponsored health insurance.
  • Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative. HIFA emphasizes statewide approaches that maximize the use of private health insurance coverage and that integrate Medicaid and SCHIP funding.
  • State-Funded Programs. States have always had the option of creating entirely state-funded programs to cover uninsured populations. State-funded programs provide states the freedom and flexibility to design programs that meet the needs of their state without being hampered by federal regulations.