More than 5.13 million children have lost their health insurance coverage through either Medicaid or the Children’s Health Insurance Program (CHIP), according to data the Center for Children and Families (CCF) published Monday.
The loss in coverage comes as a result of what’s called the Medicaid unwinding, according to a report the center published in May, “Child Medicaid Disenrollment Data Shows Wide Variation in State Performance as Continuous Coverage Pandemic Protections Lifted.”
Not only did those children lose their coverage under Medicaid or CHIP, but also fewer children were enrolled in these programs at the end of last year than were enrolled before the COVID-19 public health emergency went into effect in 2020, the report noted. When the public health emergency ended in April 2023, the continuous enrollment provisions that Congress included in the Families First Coronavirus Response Act of 2020 also ended.
For journalists attending AHCJ’s Health Journalism conference in New York City this week, be sure to attend this session, “Unwinding Medicaid: Lessons learned from a massive health insurance reshuffle,” on Friday, June 7, at 2:45 pm in the Madison room. The speakers will be Joan Alker, one of the authors of the CCF report; Amir Bassiri, the New York State Medicaid Director; Dan Tsai, Deputy Administrator and Director of the Center for Medicaid and CHIP services for CMS; and Megan Messerly, a health care reporter at Politico.
The CCF report is significant because it explained that the continuous-enrollment provisions helped more than half of all children nationwide enroll in Medicaid or CHIP and because children covered under Medicaid or CHIP come from low-income families, meaning they are among the most vulnerable Americans. The continuous-enrollment provisions helped to drop the uninsured rate among children to one of the lowest levels in recent history, according to a February 2023 CCF report titled “Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution.”
Poor health, high costs, more debt
Medicaid and CHIP coverage is vital to children’s access to health care, the May 2024 CCF report showed. “If a substantial share of the children losing Medicaid remain uninsured, as is likely, this means that a large number of low-income children are going without needed care, which will lead to poorer health in the short and long term while their families are exposed to high medical costs and medical debt,” the authors noted.
Another concern about the unwinding is that children of color are disproportionately enrolled in Medicaid, underscoring the unwinding’s potential effect on families of color, according to a June 2023 KFF report entitled “Medicaid and Racial Health Equity.”
For journalists nationwide, the CCF report is useful because it explains what’s happening with the Medicaid and CHIP unwinding in all 50 states and the District of Columbia. A table shows when the unwinding began in each state, the number enrolled at the time, the number enrolled in December 2023 and the percentage change. Using those numbers, journalists can compare each state’s performance against other states and against the national average.
The report in May explained that the more than 4.1 million children who lost coverage between April and December 2023 represents a 10% decline from the end of the COVID-19 public health emergency. For comparison, the report noted that the following seven states had declines in children enrolled in Medicaid and CHIP of more than 20%:
- South Dakota (28%).
- Montana (27%).
- Utah (25%).
- Idaho (23%).
- Texas (23%).
- Arkansas (21%).
- New Hampshire (20%).
In eight states (Alaska, Arkansas, Colorado, Idaho, Montana, New Hampshire, South Dakota and Utah), so many children were disenrolled that fewer children were covered in December than were enrolled in 2020 before the pandemic, the report said.
“This is a troubling finding given that all but one of these [eight] states had relatively low participation rates of eligible children covered by Medicaid/CHIP before the pandemic,” the report noted. Such high rates suggest that procedural barriers to re-enrollment likely result in high rates of children becoming uninsured, the authors added.
The number of children who lost coverage in four states (California, Georgia, Florida and Texas) represented half of the total number of children nationwide who were left uninsured, the report showed. Texas alone accounted for more than 1 million children who lost their coverage under Medicaid or CHIP. Next was Florida (nearly 600,000), Georgia (more than 300,000) and California (nearly 200,000), according to the report.
State-level data needed
In an interview, Joan Alker advised journalists to gather data on how many children have been unenrolled in your state and compare those numbers to the national data in the report. “There’s lots of data out there,” she said.
Such sources include the CCF report itself, and CCF’s unwinding tracker, “Medicaid Unwinding Federal Reporting, Strategies/Policies, and Data by State.” Other sources of data include the federal Centers for Medicare and Medicaid Services and KFF’s Medicaid Enrollment and Unwinding Tracker.
But even having good data may require getting an expert to guide your reporting, Alker advised. “All states are required to report data to the federal government on the unwinding, but they’re not required to disaggregate that data by race, ethnicity or age,” she explained. Some states are doing more than meeting the federal requirements.
An unprecedented task
For every state, the unwinding of Medicaid and CHIP’s continuous enrollment is a huge, unprecedented task, Alker commented. “The states have this major job that includes checking eligibility for about half of all children in the country. Some states have risen to the occasion, and some have not,” she added.
Some states are proceeding with great care to ensure that adults and children who were enrolled can re-enroll and that those enrollees can be covered consistently without having to re-enroll again, she explained.
“But then we have other states such as Georgia, Florida, Montana, South Dakota, Texas and Utah that, unfortunately, didn’t prepare to re-enroll children,” she said. “Many of those children lost their Medicaid coverage, and it’s not clear they have other coverage. In fact, there are many reasons to think that many of them do not have other coverage.”
One angle to pursue in each state is whether children and adults were unenrolled due to a procedural requirement or whether those individuals were unenrolled due to a determination of ineligibility. A procedural disenrollment occurs when a family or individual doesn’t get a renewal notice, doesn’t understand the steps needed to stay enrolled, or the family or individual has trouble navigating the state website or getting assistance via a call center, the report explained. A determination of ineligibility differs in that state officials
Nationwide, procedural terminations represent about 70% of all disenrollments, the report noted.
“It is likely that many Medicaid beneficiaries, especially children, who were disenrolled for procedural reasons remain eligible,” report authors wrote.
Resources
- “Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway,” KFF Health News, April 26, 2024.
- “20M fewer Medicaid enrollees means trouble for providers,” Modern Healthcare, April 23, 2024.
- “CMS finalizes sweeping Medicaid managed care rules,” Modern Healthcare, April 22, 2024.
- “What Can We Learn from the Unwinding of Continuous Medicaid Enrollment?,” Commonwealth Fund, April 17, 2024.
- “Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility,” JAMA Health Forum, April 5, 2024.
- “A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP,” KFF, March 15, 2024.
- “What States Are Doing to Keep People Covered as Medicaid Continuous Enrollment Unwinds,” Commonwealth Fund, Dec. 6, 2023.
- “Medicaid and Racial Health Equity,” KFF, June 2, 2023.
