CHIP and Medicaid Child Enrollment in the Southwest

Government funded programs are a critical source of health insurance coverage for children in the United States. The National Health Interview Survey (2019) estimated that just over 41% of children under the age of 18 in the U.S. have publicly funded health insurance coverage. Health benefit programs for local, state and federal government employees, including military personnel, are a source of some of the child enrollment in health insurance plans subsidized by taxpayer dollars.  However, it is the Children's Health Insurance Program (CHIP) and Medicaid that are the two key drivers of public health insurance coverage for children in the United States. Medicaid is the joint state-federal health insurance program for eligible individuals with limited income and resources.  Similarly, CHIP is a joint state-federal effort to make available health insurance for children from families with low incomes, but incomes not low enough to qualify for Medicaid coverage.  As of September 2020, federal reports indicate that there were about 37.4 million individuals who were either enrolled in CHIP or who were children enrolled in the Medicaid program.

That same September 2020 data reveals that the four-state Southwest region accounted for almost 13% of the U.S. children who were enrolled in CHIP and, excluding Arizona,  about 12% of U.S. children enrolled in the Medicaid program.  Here is a summary look at CHIP and Medicaid Child enrollment in the Southwest region of the United States:

CHIP and Medicaid Child Enrollment in the Southwest

State	(1) CHIP	(2) Medicaid Child	Total
AZ	111.8	-111.8	0.0
NM	39.7	303.0	342.7
OK	129.3	440.5	569.8
TX	591.5	3,026.7	3,618.2
Region	872.3	3,658.4	4,530.7
U.S.	6,719.1	30,641.9	37,361.0

(1) CHIP enrollment, in thousands

(2) Children enrolled in Medicaid plans, in thousands (derived by deducting State reported CHIP enrollment from State Reported Total Medicaid Child and CHIP enrollment)

Source: Medicaid.gov Enrollment Reports as of September, 2020

The Mental Health Care Shortage in the MidEast Region

The Health Resources and Services Administration (HRSA) released September 2020 data that reveals that more than 119 million Americans live in mental health care shortage areas. These areas, known as Health Professional Shortage Areas (HPSA) by the HRSA, are geographic areas, population groups, or facilities where access to mental health care services is inadequate because of a lack of mental health care providers. With respect to mental health care services, a HRSA shortage designation is based upon the number of people residing within the HPSA relative to the number of mental health care providers that service the area. Some areas earn a shortage designation based on its population relative to the number of psychiatrists in the area, while others are designated a shortage area based upon its population relative to the number of psychiatrists and core mental health providers. For HRSA purposes, core mental health providers include clinical social workers, marriage & family therapists, clinical social psychologists, and psychiatric nurse specialists. The population-to-provider ratio necessary to qualify for a shortage designation varies by HPSA type (geographic, population or facility), but all areas with a mental health care shortage have a population-to-provider ratio that meets or exceeds certain limits stipulated by federal regulations. Areas designated as having a mental health care shortage can participate in federal programs aimed at attracting more mental health care providers to work in these communities. The HRSA estimates that, as of September 2020, all mental health care shortage areas in the U.S. would need about 6,500 more mental health care providers to eliminate all such shortage designations.

The five-state MidEast region of the country has 390 mental health care shortage areas. The HPSAs in the region account for about 6.0% of the U.S. population who live in mental health care shortage areas and 8.0% of the shortage of mental health care providers nationally.  The HRSA estimates that HPSAs in the MidEast region would need over 500 more mental health care providers in order to eliminate the mental health care shortage in the region.  Here is a summary look at the mental health care shortage in the MidEast region of the United States:

The Mental Health Care Shortage in the MidEast Region

State	(1) HPSAs	(2) Population	(3) Shortage
DE	9	88.7	15
DC	10	133.9	28
MD	40	1,082.3	48
NJ	35	39.7	13
NY	177	4,102.7	315
PA	119	1,710.4	101
Region	390	7,157.7	520
U.S.	5,733	119,344.0	6,464

(1) Designated Geographic, Population Group and Facility HPSAs with a mental health care shortage

(2) Population of designated HPSAs, in thousands

(3) Mental Health Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 9/30/20 (HRSA)