North Carolina keeps child uninsurance rates below national average amid surge
Georgetown study shows NC’s 4.2% uninsured rate for kids under 6 beats 5.3% national average despite nationwide surge in uninsured children.
RALEIGH, NORTH CAROLINA — North Carolina maintained a lower rate of uninsured young children compared to the national average, even as uninsured rates for children under 6 surged across the United States, according to a new Georgetown University report released Monday.
The state’s uninsured rate for children under 6 was 4.2% in 2024, below the 5.3% national average, with 30,800 children lacking coverage according to U.S. Census Bureau data. Nationwide, 220,000 additional babies, toddlers and preschoolers became uninsured in 2024, representing a 23% increase between 2022 and 2024.
The Georgetown University Center for Children and Families report found that Texas, North Dakota, Arizona, Wyoming, Idaho, Arkansas, Florida, and Oklahoma have the highest rates of uninsured children under 6 nationwide.
State Policy Decisions Protected Coverage
Joan Alker, executive director of the Center for Children and Families and a research professor at the Georgetown McCourt School of Public Policy, credited two key decisions made during the Cooper administration for protecting thousands of children who would have otherwise lost coverage.
When states began “unwinding” Medicaid continuous enrollment after the COVID-19 pandemic, North Carolina chose a deliberate, slower approach compared to other states. “They were also one of two states in the country — North Carolina and Kentucky — that put a longer hold on their disenrollment for children,” said Alker.
“Going fast was really a risky approach, like Idaho took, but going very, very slowly and taking the time to do it right was something that North Carolina and Kentucky did, and that was a good choice,” Alker said.
Federal Waiver Provides Additional Protection
Elisabeth Wright Burak, a senior fellow at Georgetown University and lead author of the report, highlighted North Carolina’s application for a 1115 waiver from the Centers for Medicare & Medicaid Services. This waiver allows for continuous coverage for children up to age 6, making North Carolina one of just a handful of states to secure this protection.
“Before it sunsets in a few years, we’re hopeful that it will protect a lot of young children in North Carolina,” said Burak. “We’ll have to watch.”
The report comes as federal law requires all states to provide Medicaid coverage for children, but gaps in coverage can occur during enrollment transitions and administrative processes. The data represents the most recent year for which comprehensive statistics are available.
