Regina Hartfield

Regina Hartfield serves dinner for her children in their South St. Louis home. The state's Medicaid dropped her children from the program in late summer. In 2018, more than 23,000 of Missouri’s young children went without health insurance.

Missouri had the highest increase in the rate of uninsured children in the nation over the two-year period that ended in 2018, according to a study from Georgetown University. 

In 2018, 5.3 percent of Missouri children under age 6 were uninsured, up from 3.6 percent two years earlier. Nationwide, uninsured rates in that age group rose to more than 4 percent.

Not having health coverage could have severe consequences for young children, pediatricians said. Without health insurance, kids miss doctor’s appointments that can identify health problems and provide preventative care such as vaccinations.

“That’s thousands of kids who are unable to get needed medical care, both for routine checkups and for chronic conditions and diabetes,” said Dr. Ken Haller, a pediatrician at SSM Health Cardinal Glennon Children’s Hospital. “These kids will end up sicker, they’ll end up in the hospital, they’ll end up in emergency rooms.”

In 2018, more than 23,000 of the state’s young children went without health insurance.

It’s becoming more difficult for parents to sign up and keep families enrolled in health coverage, especially publicly funded programs such as Medicaid, said Elisabeth Wright Burak, the study’s author. Eligibility requirements are becoming more stringent, and parents frequently need to prove they and their family are qualified to receive coverage.

“We’re seeing more of this interest in adding what we call red tape or new conditions on eligibility and enrollment that have the effect of kicking folks off the rolls,” said Wright Burak, a senior fellow at Georgetown’s Center for Children and Families. “More and more states, I think, have the potential to cut red tape for kids and do more to make those processes more simple for families.”

Missouri’s enrollment procedures have come under fire from advocates and lawmakers after children started losing coverage under Mo Healthnet, the public insurance option for poor families in Missouri. Since mid-2018, the number of children enrolled in the program has dropped 13 percent.

Critics blamed the drop on a paper mail-based reenrollment process and computer glitches at the Missouri Department of Social Services, which administers the program.

Representatives from the department contend the drop is because they’re disenrolling people who aren’t qualified to receive Medicaid.

Missouri is one of the 17 states that haven’t expanded Medicaid to people living just above the poverty line. Those states had double the increase in uninsured rates under age 6.

That’s because when parents are insured, health care becomes a family habit, Wright-Burak said. Healthier parents mean healthier kids.

“Medicaid expansion for parents and other adults is one of the best ways to make sure we can reverse this trend,” she said.

The loss of coverage for young children could have enduring effects on development, Haller said. The American Academy of Pediatrics recommends 14 check-ups before a child’s 6th birthday.

“If kids are not getting that care and do not have that coverage at that age, it can be really devastating for them not just as children but for their entire lives,” he said. Not having insurance “can delay school entry by weeks, and they fall further and further behind.”

Those visits can also identify disabilities and problems such as poor hearing or vision that can interfere with learning.

A loss in coverage is rarely a conscious choice Haller sees parents make, he said.

“I have never once had a parent say they chose to have their child not get health insurance,” he said. “Every child needs health insurance, and every parent I have ever met wants their child to have health insurance.”

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