When Congress passed its end-of-year spending bill in December it included some important protections for children’s health care. But lawmakers also set in motion the potential uninsurance of nearly 7 million children — disproportionately Black and brown — by making April 1 the date when states can begin disenrolling them from Medicaid.
During the Public Health Emergency, Congress required states to keep children and other individuals continuously enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), a change that grew enrollment to 90 million, with children accounting for 42% of new enrollments. The “continuous coverage” requirement drove the uninsured rate among children down to 5% in 2021, its lowest level in four years.
April’s “unwinding” of these requirements threatens those gains. According to the Kaiser Family Foundation, experts predict that those who experienced the greatest growth during continuous enrollment — including children — will experience the largest enrollment declines. Congress issued restrictions on the states to minimize these declines but the trick now will be to monitor and enforce those requirements. Otherwise, millions of children could pay the price.
Five ways the “unwinding” threatens children:
- Renewal is where eligible kids tend to lose insurance: Churn rates more than doubled for children following annual renewals during one study, according to KFF, suggesting that renewal is where children fall off. By requiring continuous enrollment during the pandemic, Congress interrupted churn. While the omnibus included a 12-month continuous eligibility requirement for kids in Medicaid and CHIP, that provision does not take effect until January 1, 2024.
- Breaking up is hard to do: It’s not so easy to move from one health insurance program to another. Bureaucratic and other obstacles prevent children and others from moving between Medicaid and other coverage, including CHIP, according to KFF. Only 21% of children transitioned from Medicaid to CHIP, the study found, while 47% of children transitioned from CHIP to Medicaid. Reducing barriers to transition could prevent children who are no longer eligible for Medicaid from becoming uninsured.
- Nearly a dozen states have not expanded Medicaid, and children there are at greatest risk: In 2021, about 50 million children lived in states that had expanded Medicaid, and 27 million in states that had not, according to U.S. Census figures. About 2 million children in expansion states — or 4% — lacked health insurance, compared to 1.9 million — or 7% — in non-expansion states. Hundreds of thousands of children could lose coverage in Florida alone, according to Georgetown University Center for Children and Families.
- Children and mothers of color could suffer: Medicaid covers nearly half of all births in the United States and more than 60% of those among Black, American Indian, Native Hawaiian and other people of color. Infant and maternal mortality also run higher in these communities, in addition to higher rates of low birth weight, preterm births, and births without prenatal care. Ensuring that eligible mothers and children in these communities retain health care will protect their health and development.
- When parents are insured, children fare better, now and later: A 2017 study found that children are 29 percentage points more likely to have an annual well-child visit if their parents are enrolled in Medicaid, according to the Center on Budget and Policy Priorities. These visits and other preventive care increase children’s overall health and foster better outcomes in school and future earnings.