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Target Areas for Expanding Coverage: kids


More than 27,000 of Hawaii’s children and youth lack health coverage despite the July 2000 expansion of Medicaid’s QUEST and Fee-for-Service programs, according to the University of Hawaii Social Science Research Institute (SSRI). Of these, as many as 14,000 are eligible for government-sponsored programs but are not enrolled. SSRI reported these numbers in 2003 based on a 7-year average (1996 – 2002) of the Current Population Survey conducted by the U.S. Census Bureau.

It is believed that if all eligible children were enrolled, more than 2,500 could potentially be covered if the family income requirements were increased from 200 ($42,336 for a family of four in 2003) to 300 percent ($63,504 for family of four in 2003) of the Federal Poverty Level.

Poverty thresholds differ by the size and makeup of a household. While the Hawaii Health Survey and the U.S. Census Bureau’s Current Population Survey affirm that 2,500 are in this ‘gap group,’ the SSRI research team believes that this is an undercount.

“When the family income limits were increased to just 200 percent of the FPL, Med-QUEST’s data indicated there were only 4,000 uninsured kids in this group,” said Barbara Luksch of Hawai‘i Covering Kids, a statewide effort to find and enroll all eligible children and youth. “However, as of July 2003 more than 10,000 children and youth have been enrolled in this expansion group.”

Regular health care prevents unnecessary and expensive emergency room services, as well as helps children to be healthier and less likely to miss school and other activities.

Common untreated ailments such as sore throats, ear aches, and asthma can interfere with school attendance and result in learning problems.

Also, health insurance is required to participate in field trips, which are vital to children’s learning. Accident insurance can be purchased for field trips at a cost of $4 per day or $16 for the school year, but even this may be a burden on low-income families with several children. Moreover, such insurance only covers accidents on school outings, not regular preventive care or ordinary illness.

The following statistics were reported by Cover the Uninsured Week, a national initiative of The Robert Wood Johnson Foundation:

  • Nearly three quarters of families with uninsured children do not have access to an employer-provided health coverage plan.
  • Eight of 10 uninsured children live in households where at least one of the adults is working.
  • Most children are covered by an employer-based plan or privately purchased health plan, but Medicaid covered nearly one in four.
  • One in five parents of uninsured children has kept or would keep their children from participating in extracurricular sports because they fear that their children might get injured.
  • In 2001, children 12-17 years of age were more likely to be uninsured than those younger than 12.

QUEST & Medicaid Fee-for-Service Programs

84,100 in Children & Youth Enrolled


Benefits of Both Programs
Regular Medical Check-ups Prescription Drugs
Immunizations Vision & Dental Care
Physician Visits Emergency Care
Mental Health Services

QUEST. For children and youth who are not in a pubic institution nor certified blind or disabled.

Medicaid Fee-For-Service. Pays healthcare providers directly for their services and participants must be certified by the state as blind or disabled.

State’s “Expansion” Programs Boosts Coverage:
11,450 Kids Enrolled


State Children’s Health Insurance Program (SCHIP). With enhanced federal matching rates in July 2000, this program allowed states to expand their Medicaid programs (QUEST & Medicaid Fee-for-Service) to include kids in families with incomes up to 200 percent of the FPL. This has meant health coverage for 9,474 children in 2003.

Immigrant Children’s Program. This program allows all immigrant children and youth to receive public health coverage. Compact states include the Marshall Islands, Federated States of Micronesia and Republic of Palau. This has meant coverage for 1,981 Pacific Island children from these locations.

Hawaii’s Only Private Insurance Option


This plan is available to Hawaii’s children from 1 month to 18 years old. At a monthly fee of $58.50 in 2003, it provides limited services, such as preventive care, immunizations, and doctor visits.

The Hawai‘i Uninsured Project has formed a committee of advocates, health care and health coverage experts, and state officials to develop and analyze potential solutions for increasing coverage for children, with an emphasis on those in families with incomes from 200 to 300 percent of the FPL.