Usual Source of Health Care, by Income Level
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- Definition: Estimated percentage of children ages 0-17, by usual source of health care and income level (e.g., in 2017-2018, among California children living below 200% of their federal poverty threshold, 12.3% had no usual source of health care).
- Data Source: UCLA Center for Health Policy Research, California Health Interview Survey (Aug. 2020).
- Footnote: The federal poverty threshold was $25,465 for a family of two adults and two children in 2018. These estimates are based on a survey of the population and are subject to both sampling and nonsampling error. The notation S refers to data that have been suppressed because the sample size was lower than 50, the percentage was less than 0.1, or the estimate was suppressed by the UCLA Center for Health Policy Research. Data may have wide margins of error and should be treated with caution. For more information and margins of error around specific estimates, visit the California Health Interview Survey. N/A means that data are not available.
Learn More About Health Care
- Measures of Health Care on Kidsdata.org
Kidsdata.org's health care measures include:
* Public health insurance includes both means-tested coverage (e.g., Medicaid/Medi-Cal, CHIP) and non-means-tested coverage (e.g., Dept. of Defense TRICARE, Indian Health Service). Means testing considers financial circumstances in determining eligibility.
- Children ages 0-18 with and without health insurance, by type of coverage (public* or private), age group, and race/ethnicity (see list)
- Children and youth ages 0-21 with Medicaid (Medi-Cal), Children's Health Insurance Program (CHIP), or other means-tested public health insurance† (see list); also, for California and the U.S. only, coverage by age group and race/ethnicity
- Total yearly enrollment in Medicaid (Medi-Cal) and CHIP among children ages 0-18 (California and U.S. only)
- Average monthly enrollment in Medi-Cal among children and youth ages 0-20, by age group, and, for California only, by race/ethnicity and most common written languages
- Children ages 0-17 uninsured at any point in the previous 12 months
- Children ages 0-17 for whom needed health care was delayed or not received in the previous 12 months, and, for California only, by main reason for delaying or forgoing care
- Youth ages 12-17 by the length of time since their last routine health check-up
- The usual source of health care for children ages 0-17, by income level and race/ethnicity
- Children ages 0-17 who receive care within a medical home‡
- The number of school-based or -linked health centers serving public schools
- The extent to which students are provided adequate health services at school, as reported by staff
† Medicaid is a federal program providing health coverage to eligible low-income children and families; Medi-Cal is California's Medicaid program. Children's Health Insurance Program (CHIP) is a federal program providing coverage to children up to age 19 in families with incomes too high to qualify them for Medicaid, but too low to afford private coverage. California's CHIP program was called the Healthy Families Program (HFP). Although California continues to receive CHIP funding, in 2013 HFP enrollees were transitioned into Medi-Cal.
‡ A medical home is a model of delivering primary care that accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective. For more information, visit the American Academy of Pediatrics.
- Health Care
- Health Insurance Coverage, by Type and Age Group
- Health Insurance Coverage Status, by Race/Ethnicity
- Medicaid (Medi-Cal) or Children's Health Insurance Program (CHIP) Coverage
- Medicaid (Medi-Cal) or CHIP Coverage, by Age Group (California & U.S. Only)
- Medicaid (Medi-Cal) and CHIP Yearly Enrollment (California & U.S. Only)
- Medi-Cal Average Monthly Enrollment
- Uninsured at Any Point in Past Year
- Medical Care Delayed or Forgone in Past Year
- Length of Time Since Teen's Last Check-Up
- Usual Source of Health Care
- Receipt of Care Within a Medical Home
- School Health Centers
- School Provides Adequate Health Services (Staff Reported)
- Characteristics of Children with Special Needs
- Access to Services for Children with Special Needs
- Children's Emotional Health
- Health Insurance Coverage for Children with Special Health Care Needs
- Quality of Care for Children with Special Health Care Needs
- Receipt of Care Within a Medical Home for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Needed Care Coordination for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Family-Centered Care for Children with Special Health Care Needs (California & U.S. Only)
- Dental Care
- Hospital Use
- Youth Suicide and Self-Inflicted Injury
- Prenatal Care
- Why This Topic Is Important
According to the American Academy of Pediatrics, every child should receive high quality health care that is accessible, family centered, culturally competent, coordinated, continuous, compassionate, and comprehensive (1). This care is best offered through a medical home, an ongoing family-centered partnership with a child health professional or team in which all of the patient's needs are met (1). Children who receive care in the context of a medical home are more likely to have regular preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have emergency room visits (1). However, the latest estimates indicate that less than half of children receive care within a medical home, statewide and nationally (2).
Not surprisingly, children without health insurance are less likely to access needed care than those with coverage (3). While the percentage of uninsured children has decreased in recent years, many remain without coverage, and many insured children are at risk of losing coverage if investments in public insurance programs are not maintained (3).One convenient way for children and youth to access needed services is through school-based health centers (SBHCs). These centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, such as primary medical care, mental or behavioral health care, dental care, substance abuse services, and health and nutrition education. More than 2,500 SBHCs operate nationwide (4). These centers have become a key part of the health care delivery system, as children and youth spend a significant amount of time at school, and barriers such as transportation and scheduling are reduced. SBHCs can lead to improved access to medical and dental care, health outcomes, and school performance (5, 6). They also reduce emergency room visits and health care costs (5, 6).
For more information on health care, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. National Resource Center for Patient/Family-Centered Medical Home. (2020). Why is medical home important? American Academy of Pediatrics. Retrieved from: https://medicalhomeinfo.aap.org/overview/Pages/Evidence.aspx
2. As cited on kidsdata.org, Receipt of care within a medical home. (2021). National Survey of Children's Health.
3. Schneider, L., et al. (2016). The Affordable Care Act and children's coverage in California: Our progress and our future. The Children's Partnership. Retrieved from: https://www.childrenspartnership.org/research/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future
4. Love, H., et al. (2018). 2016-17 national school-based health care census. School-Based Health Alliance. Retrieved from: https://www.sbh4all.org/what-we-do/school-based-health-care/national-census-of-school-based-health-centers
5. American Academy of Pediatrics Council on School Health. (2019). School-based health centers and pediatric practice. Pediatrics, 129(2), 387-393. Retrieved from: https://pediatrics.aappublications.org/content/129/2/387
6. Community Preventive Services Task Force. (2016). Promoting health equity through education programs and policies: School-based health centers. Retrieved from: https://www.thecommunityguide.org/sites/default/files/assets/Health-Equity-School-Based-Health-Centers_1.pdf
- How Children Are Faring
An estimated 97% of California children ages 0-18, and 95% of children nationwide, had some form of health insurance coverage in 2018—up from less than 90% in 2008. Despite these gains, gaps persist. For example, 8% of American Indian/Alaska Native children in California were uninsured in 2018, more than twice the estimate for children in other racial/ethnic groups.
Two in every three California children ages 0-18 (67%) were enrolled in Medicaid or CHIP at some point in the 2019 federal fiscal year, a larger share than the percentage enrolled nationally (58%). On average, nearly half (49%) of the state's young people ages 0-20 were enrolled in Medi-Cal per month in calendar year 2020, with figures ranging from 28% (Placer) to 77% (Lake) across counties with data. Statewide, average monthly Medi-Cal enrollments among African American/black (61%) and Hispanic/Latino (59%) children and youth were more than double the enrollment rates for their Asian/Pacific Islander (28%) and white (22%) peers.
Parent reports from 2016-2019 show that 43% of the state's children ages 0-17 received care within a medical home, compared with 48% nationwide. Across California regions, estimates of children receiving care within a medical home ranged from 35% (Merced County) to 54% (Marin County).In 2017-2018, 9% of California children ages 0-17, and 12% of lower-income children, had no usual source of health care. Estimates by race/ethnicity ranged from 8% (white, multiracial) to 18% (Hispanic/Latino). Statewide and across demographic groups, children's usual source of health care was most commonly a doctor's office or HMO, rather than hospitals, clinics, urgent care, emergency rooms, or other settings. For children living below 200% of the federal poverty threshold, 45% usually used a doctor's office or HMO, compared with 76% of children in higher-income families. Among children who needed medical care in 2017-2018, 3% either did not receive the care they needed or received it after a delay. For around a third of these children (32%), needed care was delayed or foregone for cost or insurance reasons, and for a quarter (25%) because of system or provider issues.
California had 291 school health centers in 2021, up from 153 in 2009. However, many of the state's counties (23 of 58) did not have any school health centers in 2021. When asked whether their school provides adequate health services for students, 29% of responses from elementary school staff, 26% of responses by middle school staff, 22% of responses by high school staff, and 31% of responses by staff at non-traditional schools reported strong agreement in 2017-2019.
- Policy Implications
Children with health insurance are more likely to receive needed medical care, are less likely to have costly hospitalizations, and tend to perform better in school than their uninsured peers (1). Providing quality, accessible, and affordable health care to all children requires comprehensive insurance coverage and an appropriately trained and compensated provider base including a sufficient number of subspecialists; it also requires effective systems of care including medical homes and parental understanding about what care is needed and how to obtain it (2, 3, 4). Immigrant children, especially those with undocumented parents or those who are themselves undocumented, are at particular risk of being uninsured and without regular health care (2, 5).
The Affordable Care Act, which expanded health care coverage and enacted other major health system changes, has increased the percentage of insured children in the state and nation (2). California also has enacted numerous policy and program changes in recent years, bolstering coverage and access to health care for millions of children and families (2). While progress has been made, ongoing efforts are needed to maintain these gains and to continue strengthening children's health care, particularly for low-income and vulnerable populations (2).
Policy options that could improve children's health care include:
For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section or visit the California Health Care Foundation, the National Academy for State Health Policy, and the American Academy of Pediatrics.
- Supporting ongoing efforts to ensure continuous insurance coverage for all low-income children, including immigrant children; this includes maintaining and increasing investments in public insurance programs serving children, and continuing to improve enrollment processes and community-based outreach to families (2, 5)
- Ensuring that every child has access to family centered, culturally competent, and coordinated care within a medical home, particularly children with chronic conditions (3, 6)
- Increasing the number of health care providers serving children in Medi-Cal (California's Medicaid program) by improving financial incentives and ensuring that reimbursement for pediatric visits covers the time required to focus on children's development and family-centered care (2, 4, 6)
- Ensuring that there is an adequate number of pediatric specialty care providers and that pediatricians are trained on management of care for children with special health care needs, medical home implementation, and culturally effective pediatric practice (3, 4)
- Expanding access to health consultation and education for families and service providers in programs serving young children, such as child care settings, home-visiting programs, and foster care homes (6)
- Monitoring the capacity and financial viability of safety net providers, such as county hospitals, which are important sources of care for low-income people (7)
- Promoting collaboration across sectors—health, education, social services, and others—to improve prevention, early intervention, and treatment services for children, and supporting a comprehensive approach to health care that goes beyond treating illness to addressing community factors that impact health, such as access to healthy food or safe housing; in these ways, health inequities at the population level could be reduced and costs related to preventable conditions lowered (8, 9)
Sources for this narrative:
1. Murphey, D. (2017). Health insurance coverage improves child well-being. Child Trends. Retrieved from: https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well
2. Schneider, L., et al. (2016). The Affordable Care Act and children's coverage in California: Our progress and our future. The Children's Partnership. Retrieved from: https://www.childrenspartnership.org/research/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future
3. National Resource Center for Patient/Family-Centered Medical Home. (2020). Why is medical home important? American Academy of Pediatrics. Retrieved from: https://medicalhomeinfo.aap.org/overview/Pages/Evidence.aspx
4. American Academy of Pediatrics Committee on Pediatric Workforce. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397. Retrieved from: https://pediatrics.aappublications.org/content/132/2/390
5. Linton, J. M., et al. (2019). Providing care for children in immigrant families. Pediatrics, 144(3), e20192077. Retrieved from: https://pediatrics.aappublications.org/content/144/3/e20192077
6. Kossen, J., & Rosman, E. (2012). Leading the way to a strong beginning: Ensuring good physical health of our infants and toddlers. Zero to Three. Retrieved from: https://www.zerotothree.org/resources/996-leading-the-way-to-a-strong-beginning-ensuring-good-physical-health-of-our-infants-and-toddlers
7. Cha, P., & McConville, S. (2020). California's future: Health care. Public Policy Institute of California. Retrieved from: https://www.ppic.org/publication/californias-future-health-care
8. Halfon, N., et al. (2014). The changing nature of children's health development: New challenges require major policy solutions. Health Affairs, 33(12), 2116-2124. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0944
9. Arkin, E., et al. (Eds.). (2014). Time to act: Investing in the health of our children and communities. Robert Wood Johnson Foundation Commission to Build a Healthier America. Retrieved from: https://www.rwjf.org/en/library/research/2014/01/recommendations-from-the-rwjf-commission-to-build-a-healthier-am.html
- Research & Links
- Websites with Related Information
- California Coverage and Health Initiatives
- California Dept. of Health Care Services
- California Health Care Foundation
- California School-Based Health Alliance
- Center for Health and Health Care in Schools. George Washington University.
- Children's Partnership: Health Coverage
- Commonwealth Fund
- Family Health Outcomes Project. University of California, San Francisco.
- Georgetown University Center for Children and Families
- Health Affairs. Project HOPE.
- Health Insurance and Access to Care for Children and Adolescents: Professional Resource Guide. Maternal and Child Health Digital Library.
- National Academy for State Health Policy (NASHP)
- National Resource Center for Patient/Family-Centered Medical Home. American Academy of Pediatrics.
- Prevention Institute
- Robert Wood Johnson Foundation: Building a Culture of Health
- Social Determinants of Health: Know What Affects Health. Centers for Disease Control and Prevention.
- UCLA Center for Health Policy Research
- Key Reports and Research
- A New Pediatrics for a New Century. (2013). Pediatrics. Lantos, J. D., & Ward, N. A.
- Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance. (2021). Commonwealth Fund. Radley, D.C., et al.
- An Update on the Portrait of Promise: Demographic Report on Health and Mental Health Equity in California. (2020). California Dept. of Public Health, Office of Health Equity.
- California's Future: Health Care. (2020). Public Policy Institute of California. McConville, S., & Cha, P.
- Changes in Children’s Health Coverage Varied by Poverty Status from 2018 to 2020. (2021). U.S. Census Bureau. Bunch, L. N., & Bandekar, A. U.
- Childhood Medicaid Coverage and Later-Life Health Care Utilization. (2018). The Review of Economics and Statistics. Wherry, L. R., et al.
- Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. (2020). Pediatrics. American Academy of Pediatrics Committee on Child Health Financing.
- Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making. (2015). Pediatrics. American Academy of Pediatrics Committee on Pediatric Workforce.
- How Does California Perform on the Quality of Health Care for Children Enrolled in Medicaid and CHIP? (2016). Georgetown University Center for Children and Families. Brooks, T., et al.
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems. (2018). Pediatrics. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee.
- Policies to Promote Child Health. (2015). The Future of Children.
- Promoting Health Equity Through Education Programs and Policies: School-Based Health Centers. (2016). Community Preventive Services Task Force.
- Providing Care for Children in Immigrant Families. (2019). Pediatrics. Linton, J. M., et al.
- School-Based Health Centers and Pediatric Practice. (2017). Pediatrics. American Academy of Pediatrics Council on School Health.
- Scorecard on State Health System Performance. (2019). Commonwealth Fund. Radley, D. C., et al.
- State Medicaid and CHIP Snapshots. (2019). Georgetown University Center for Children and Families & American Academy of Pediatrics.
- Why Is Children's Enrollment in Medi-Cal Lagging in California at a Time When Children Are in Most Need? (2021). The Children's Partnership.
- County/Regional Reports
- 2023 California County Scorecard of Children's Well-Being. Children Now.
- Annual Report on the Conditions of Children in Orange County. Orange County Children's Partnership.
- Community Health Improvement Plan for Los Angeles County. Los Angeles County Dept. of Public Health.
- Key Indicators of Health by Service Planning Area. (2017). Los Angeles County Dept. of Public Health.
- Live Well San Diego Report Card on Children, Families, and Community. The Children’s Initiative.
- Los Angeles: Thriving or Surviving in a Fragmented Market. (2016). California Health Care Foundation. Felland, L., et al.
- Orange County Community Indicators Report. Orange County Business Council, et al.
- Pathway to Progress: Indicators of Young Child Well-Being in Los Angeles County. First 5 LA.
- San Mateo County All Together Better. San Mateo County Health.
- Santa Clara County Children's Data Book. Santa Clara County Office of Education, et al.
- More Data Sources For Health Care
- 2022 KIDS COUNT Data Book: State Trends in Child Well-Being. Annie E. Casey Foundation.
- Ambulatory Health Care Data. National Center for Health Statistics.
- California Health and Human Services Open Data Portal. California Health and Human Services Agency.
- California Health Interview Survey. UCLA Center for Health Policy Research.
- California Strong Start Index. First 5 Association of California & Children’s Data Network.
- Childstats.gov. Federal Interagency Forum on Child and Family Statistics.
- Community Commons: Community Health Needs Assessments
- County Health Rankings and Roadmaps. Robert Wood Johnson Foundation & University of Wisconsin Population Health Institute.
- Coverage, Access, and Affordability in California: Key ACA Data 2013-2016. California Health Care Foundation.
- National Survey of Children's Health. Child and Adolescent Health Measurement Initiative.
- The Well-Being and Basic Needs Survey. Urban Institute.
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