Medical Expenditure Panel Survey 

Agency for Healthcare 

Research and Quality 

STATISTICAL BRIEF #100 

September 2005 

Trends in Children’s Eligibility for 

Public Insurance for Families with 

Children, 1996–2002 (First Half) 

Julie Hudson 

Introduction 

Children’s eligibility for public insurance in the United States is 

typically determined at the family level. Family income, family size, 

and age of child are the key components to determining eligibility for 

both Medicaid and the State Children's Health Insurance Program 

(SCHIP). Nevertheless, statistics for children’s eligibility for public 

health insurance are often reported at the person level. 

Family-level statistics provide a different aspect on children’s 

eligibility. They have the potential to differ from child-level statistics 

because families often have multiple children in the same household. 

Children who are eligible for public insurance may be concentrated 

in a small subset of large families or may be spread across many 

smaller families. Also, because Medicaid income thresholds for 

eligibility can vary by age, children in the same family may have 

differing eligibility. When families have multiple children with different 

types of eligibility or have varying concentrations of children with the 

same type of eligibility, family-level statistics provide additional 

information for researchers that is not available at the child level. All 

estimates in this brief are presented at the family level and include 

only those families with children age 18 and under.1 

This Statistical Brief presents estimates from the KIDSIM eligibility 

simulation model for the population of children in the Medical 

Expenditure Panel Survey (MEPS) in the first part of calendar years 

1996 through 2002. The KIDSIM model supplements MEPS data 

with annual state-level eligibility rules for both Medicaid and SCHIP. 

For ease of presentation, the word “family” will be used to represent 

families with children ages 18 and under. For this analysis, families 

are constructed to include adults and children who would typically be 

eligible for coverage under the adults’ private health insurance family 

plans (for example, children and their parents). Eligibility rules are 

applied to these families using the appropriate definition of family for 

the program in question: Medicaid or SCHIP. 

Highlights 

¢ In the first part of 2002, 48.2 

percent of families had at 

least one child who was 

eligible for public insurance, 

an increase of almost 18 

percentage points over the 

first part of 1996. This represented 20.3 million families, 

an increase of over 8 million 

families. 

¢ Increases in the percentage of 

families with at least one child 

eligible for public insurance 

were primarily due to the 

implementation and expansion of the SCHIP program. 

¢ Between 1996 and 2002, the 

percentage of families with at 

least one child eligible for 

Medicaid was relatively stable 

at between 27 percent and 29 

percent while those with at 

least one child eligible for 

SCHIP increased almost 20 

percentage points from 1.8 

percent to 21.7 percent. 

¢ In the first part of 2002, 51.8 

percent of families had no 

children eligible for public 

insurance; 26.1 percent had 

all their children eligible for 

Medicaid; 19.2 percent had all 

their children eligible for 

SCHIP; and 2.8 percent had 

children with different types of 

eligibility for public insurance. 

¢ From the first part of 1996 to 

the first part of 2002, families 

with no children eligible for 

public insurance decreased by 

18 percentage points; those 

with all children eligible for 

SCHIP increased by 18 percentage points; and those with 

children of differing eligibility 

decreased by 2 percentage 

points. 

1 Selden, T. M., Hudson, J. L. and Banthin, J. S. Tracking Changes in Eligibility and 

Coverage among Children, 1996–2002. Health Affairs 23, no. 5 (2004): 39–50. This 

article presents MEPS estimates for children’s eligibility for public health insurance at 

the person level. 
Children’s eligibility for public insurance at the family level is reported using a variety of statistics. The 

prevalence of eligibility is reported as both the percentage and the number of families with at least one 

child eligible for public insurance. Separate estimates are given for the percentage of families where at 

least one child is eligible for Medicaid and for SCHIP. A more detailed measure reports children’s 

eligibility for public insurance across four categories: 1) families where all children are not eligible for 

public insurance, 2) families where all children are eligible for Medicaid, 3) families where all children 

are eligible for SCHIP, and 4) families where children in the same family have different types of 

eligibility for public insurance (for example, one child may be eligible for SCHIP while another is eligible 

for Medicaid or is not eligible at all). 

All differences between estimates discussed in the test are statistically significant at the 0.05 level 

unless otherwise noted. 

Findings 

In the first part of 2002, 48.2 percent of U.S. families had at least one child eligible for public insurance 

(figure 1). This represents a significant increase of almost 18 percentage points since the first part of 

1996, when 30.3 percent of families had at least one eligible child. The number of families with at least 

one child eligible for public insurance increased dramatically by over 8 million from 12.1 million in the 

first part of 1996 to 20.3 million in the first part of 2002 (figure 2). 

Much of the increase in children’s eligibility has been driven by families whose children gained eligibility 

through the implementation of the SCHIP program. The percentage of families with at least one child 

eligible for SCHIP increased almost 20 percentage points between the first parts of 1996 and 2002 (1.8 

percent to 21.7 percent) with the largest gains seen between 1998 and 2001 (figure 3). Meanwhile, the 

percentage of families where at least one child was eligible for Medicaid remained relatively stable, 

between 27 percent and 29 percent. 

In the first part of 2002, the majority of U.S. families, 51.8 percent, had no children eligible for public 

insurance (figure 4). This represents 21.9 million families with children (not shown). Among the families 

with at least one child eligible for public insurance, most families had all their children eligible for 

Medicaid: 11.0 million (not shown), or 26.1 percent, of all families had all Medicaid-eligible children 

(figure 5). Alternatively, 8.1 million (not shown), or 19.2 percent of families, had all children eligible for 

SCHIP (figure 4). A small percentage of families (2.8 percent) had children with differing eligibility in the 

same family. All 1.2 million (not shown) of these families had at least one child eligible for public 

insurance (either Medicaid or SCHIP or both) but 23.8 percent (not shown) of these families also had at 

least one child who was not eligible for public insurance. 

In a comparison to children’s eligibility for public insurance for families in the first part of 1996, 

increases in children’s eligibility for public insurance in families with children by 2002 were primarily 

driven by increases in families with all children eligible for SCHIP (figure 5). The percentage of families 

with no children eligible for public insurance dropped 18 percentage points between 1996 and 2002 

(from 69.7 percent to 51.8 percent), and the percentage of families with all children eligible for SCHIP 

increased by 18 percentage points (from 1.1 percent to 19.2 percent). Over the same time period, the 

percentage of families with all children eligible for Medicaid went from 23.9 percent to 26.1 percent 

while the percentage of families with mixed eligibility dropped from 5.3 percent to 2.8 percent. 

Data Source 

The estimates provided in this Statistical Brief come from the KIDSIM model, created and maintained 

by AHRQ’s Division of Modeling and Simulation in the Center for Financing, Access, and Cost Trends. 

This model uses 1996 through 2002 MEPS Household Component Files (HC-01, HC-05, HC-09, HC13, HC-22, HC-34, and HC-53) with point-in-time estimates for the early part of calendar years 1996

through 2002 for Round 1 persons in Panels 1 through 7 and Round 3 persons in Panels 1, 2 and 4 

through 6. The Household Component point-in-time files contain data on family structure, employment, 

health insurance, health status, and demographic characteristics of both individuals and households for 

the first part of the calendar year. 
Definitions 

Family 

Families are constructed to include adults and those family members who would typically be eligible for 

coverage under the adults’ private health insurance family plans, a grouping otherwise known as health 

insurance eligibility units (HIEUs). These families comprise adults, their spouses and their unmarried 

natural/adoptive children age 18 and under. Unmarried minors living without their natural/adoptive 

parents are included in the family of their stepparent, grandparent, or aunt/uncle. Married minor children 

are placed in a separate family with their spouses and their own children. Children of unmarried minors 

are placed, along with their minor parent, in the family of their adult grandparents. Foster children and 

unmarried minors living without any adult family member constitute their own independent families 

without adults. 

Family definitions may differ from the HIEU concept when counting family income and family size for 

Medicaid or SCHIP eligibility. While statistics in this brief are presented for families using the HIEU 

definition, the KIDSIM model follows the appropriate family definition for calculating eligibility. 

Age 

Children are ages 18 and under. Note that some other MEPS Statistical Briefs use different age ranges 

for children and adults and will report slightly different estimates for insurance status. 

Eligibility for public insurance for children 

Eligibility for public insurance for children is calculated for the population of children in MEPS using 

state-level eligibility rules in AHRQ’s KIDSIM model. Eligibility is calculated for Rounds 1 and 3 of the 

survey. In these files, the round took place in the first part of calendar years 1996 through 2002. 

Individual eligibility for public insurance is defined by the following mutually exclusive categories: 1) 

eligible for Medicaid, 2) eligible for SCHIP, and 3) not eligible for public insurance. Some states ran 

SCHIP-like programs with premiums via waivers before SCHIP was implemented and later converted 

these programs to SCHIP. KIDSIM simulates these programs in the pre-SCHIP years, and children 

eligible for these state-level programs are included in the SCHIP category. 

Eligibility for public insurance for families 

Children’s eligibility for insurance at the family level is based on the eligibility status of the children 

within each family and, therefore, also reflects eligibility in Rounds 1 and 3 of the survey. This 

represents eligibility for public insurance in families for the first part of calendar years 1996 through 

2002. Family-level eligibility for public insurance is defined by the following mutually exclusive 

categories describing eligibility for public insurance for children within the family: 1) all children not 

eligible for public insurance, 2) all children eligible for Medicaid, 3) all children eligible for SCHIP, and 4) 

children in the same family with differing eligibility for public insurance. An example of category 4 is a 

family with one child who is eligible for SCHIP and another child who is eligible for Medicaid (or one 

who is not eligible for any public insurance). 

Statistics on A) families with at least one child eligible for Medicaid and B) at least one child eligible for 

SCHIP are not mutually exclusive. If a family has a one child who was eligible for Medicaid and another 

child who was eligible for SCHIP, they would be represented in categories A and B. However, in the 

measure above, they would appear in category 4 (but not in category 2 or category 3). 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of 

social, demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 
References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care 

Policy and Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care 

Policy and Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, 

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Hudson, J. L. Trends in Children’s Eligibility for Public Insurance for Families with Children, 1996–2002 

(First Half). Statistical Brief #100. September 2005. Agency for Healthcare Research and Quality, 

Rockville, Md. http://www.meps.ahrq.gov/papers/st100/stat100.pdf 

� � �

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD 

Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

47.1 48.2

31.5 34.0 39.4

43.3

30.3

0

20

40

60

1996 1997 1998 1999 2000 2001 2002

Any child eligible for public insurance in family

Figure 1. Trends in children’s eligibility for public 

insurance for families with children, 1996–2002

Percentage of families 

with children

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

20.3 19.6

13.0 14.0 16.0

17.8

12.1

0

10

20

30

1996 1997 1998 1999 2000 2001 2002

Any child eligible for public insurance in family

Number of families With

children (

millions)

Figure 2. Trends in children’s eligibility for public 

insurance for families with children, 1996–2002
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

29.0 29.0 27.9 28.7 27.7 26.728.9

21.6 21.7

15.0

6.7

1.8 3.0

19.0

0

10

20

30

40

1996 1997 1998 1999 2000 2001 2002

Any child eligible for Medicaid in family

Any child eligible for SCHIP in family

Figure 3. Trends in children’s eligibility for 

public insurance for families with children:

Medicaid and SCHIP, 1996–2002

Percentage of families 

with children

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

26.1%

19.2%

51.8%

2.8%

All children not eligible

All children eligible for Medicaid

All children eligible for SCHIP

Children with mixed eligibility

Figure 4. Children’s eligibility for public 

insurance for families with children, 2002
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

19.2

2.8 5.3

1.1

23.9

69.7

51.8

26.1

0

20

40

60

80

All children not

eligible

All children

eligible for

Medicaid

All children

eligible for SCHIP

Children with

mixed eligibility

1996 2002

Figure 5. Children’s eligibility for public insurance 

for families with children, 1996 versus 2002

Percentage of families 

with children