More than  4.6 million children have lost Medicaid coverage due to the “unwinding” of health care protections put in place during the COVID-19 pandemic. In some states, such as Texas, nearly two-thirds of the children enrolled have lost their coverage since the unwinding began in April of 2023. And according to early estimates, the “vast majority” of kids losing access to critical health coverage are still actually eligible for it, but have been disenrolled because of “bureaucratic snafus.”

How did we get here?

Once the Administration declared COVID-19 a 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.

When the public health emergency ended, so did the prohibition on kicking people off Medicaid and CHIP.  Congress set April 1, 2023, as the date when states could begin disenrolling children and families who no longer qualified and could resume requiring people to prove their eligibility. During this process — the aforementioned “unwinding” — states were tasked with redetermining the status of the 85 million individuals enrolled in Medicaid, including more than  34.7 million children.

First Focus on Children warned from the start that if state Medicaid agencies did not proceed with caution, millions of people would unnecessarily lose coverage. Unfortunately, the new figures demonstrate that these fears have materialized. 

What do we do now?

Since the start of the unwinding, First Focus on Children has been calling on the Department of Health and Human Services to protect children’s health by holding states accountable, encouraging states to be proactive in implementing the new federal requirement to provide 12 months of continuous eligibility for children in Medicaid and CHIP and partnering with states to adopt the Express Lane Eligibility option. Moving forward, coming out of the unwinding is an opportunity to improve the nation’s health care system  to better serve children, by: