Kidsdata.org's health care measures include:

• 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 young adults 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 young adults 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 health 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

According to the American Academy of Pediatrics, every child should receive high-quality health care that is accessible, family centered, culturally effective, coordinated, continuous, compassionate, and comprehensive (1). This care is best delivered through a medical home—a primary care model in which all of a child's health needs are met through partnerships between the family, clinical professionals, and community resources (1). This model is associated with better health outcomes and lower costs, as 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 unmet needs, emergency room visits, and in-patient hospital stays (1). However, 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). The percentage of California and U.S. children without health insurance has risen in recent years, after declining over the previous decade (4, 5). If investments in public insurance programs are not maintained, and additional efforts made to enroll and retain eligible children, even more are at risk of losing coverage (3, 4, 5).

An estimated 97% children ages 0-18 in California, and 95% of U.S. children, had some form of health insurance coverage in 2016-2020. Rates vary across counties with data, and were as low as 90% for this period. Gaps by race/ethnicity also persist: For example, around 1 in 15 American Indian/Alaska Native children statewide were uninsured in 2016-2020, compared with 1 in 25 Hispanic/Latino children, and fewer than 1 in 40 white children.

Two in every three California children ages 0-18 (67%) were enrolled in Medicaid or CHIP at some point during 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 health 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).

Children with health insurance are more likely to receive the medical care they need, are less likely to have costly emergency room visits and hospitalizations, and tend to have better health and educational outcomes than their uninsured peers (1, 2). Providing quality, accessible, and affordable health care to all children requires comprehensive, continuous insurance coverage and an appropriately trained and diverse provider base with a sufficient number of subspecialists; it also requires effective systems of care, including medical homes, in which parents, clinicians, and service providers are partners in a whole-family approach to improving child health (2, 3). Children of color and those living in poverty or in immigrant families—especially children with undocumented parents—are at particular risk of being uninsured and without regular health care (1, 2, 4).

The U.S. health policy landscape has changed significantly in the last two decades. The Affordable Care Act and expansion of the Child Health Insurance Program led to the lowest percentages of uninsured children in U.S. history (1, 2). California's investments and policymaking further bolstered coverage and access to care for many of the state's children and families (5). However, the share of children without health insurance has increased in recent years, statewide and nationally, threatening to undo progress (4, 6, 7). Additionally, the COVID-19 pandemic has exacerbated existing challenges in access to care, particularly among already vulnerable groups (1, 6, 8). Concerted efforts are needed to maintain gains of the previous decade and to continue strengthening children's health care systems (2, 6, 7, 8).

Policy and systems strategies that could improve children's health care include:

• Supporting ongoing efforts to ensure continuous insurance coverage for all low-income children and families, including immigrant families; this includes maintaining investments in public insurance programs serving children and continuing to improve enrollment processes and community-based outreach to families (1, 2, 7)
• Improving financial incentives for providers serving children in Medi-Cal (California's Medicaid program), particularly in underserved communities (2, 5)
• Ensuring that all children, particularly those with chronic conditions, have access to family centered, culturally competent, and coordinated health care; that there is an adequate number of pediatric specialty care providers; and that pediatricians are trained on medical home implementation and management of care for children with complex needs (2, 3, 5)
• Increasing the diversity of the health care workforce and expanding training for health professionals on culturally effective practice (2, 3)
• Promoting health education for families and providers in service settings, such as child care, home-visiting programs, and foster care homes (2)
• Ensuring the financial viability of safety net providers, such as county hospitals and community clinics, which are important sources of care for low-income people and undocumented immigrants (5)
• Continuing to expand school-based health services, which have been shown to improve access to care for students of color and low-income children (9, 10)
• Promoting collaboration across sectors—health, education, social services, and others—to improve prevention, screening, and early intervention services for children; also, supporting a comprehensive approach to health care that goes beyond treating illness to addressing social determinants of health, such as access to healthy food and safe housing (2)