The situation presents a “unique and unprecedented set of public policy circumstances that create a grave risk to the stability of health coverage in the year ahead for millions of children and their families,” said Joan Alker, executive director of the Georgetown center and co-author of the report.
Some 4.4 million children were uninsured in 2019, according to the latest figures available from the US Census Bureau.
Children at risk
Since they will lose the boost in federal Medicaid matching funds, states will be under great pressure to conduct the eligibility reviews quickly and reduce their enrollment, Alker said.
Not enough attention is being paid to the risks children are facing of becoming uninsured and to transitioning them to other forms of coverage, the analysis said.
“Even children who remain eligible for Medicaid could lose their coverage for procedural reasons, such as the verification request getting lost in the mail or being sent to an old address,” said Tricia Brooks, research professor at Georgetown’s McCourt School of Public Policy and a co-author of the report.
Even prior to the pandemic, many families were dropped from Medicaid for administrative hurdles or income fluctuations — though 44% of these children were reenrolled within a year.
Families have experienced a lot of changes since they last had to renew their eligibility two years ago, Alker said. She expects to see a record number of denials for procedural reasons due to the volume of verifications and the push to act on them quickly.
A majority of kids who lose Medicaid because their families’ income has increased modestly could probably shift to CHIP, which has higher earnings limits. But some states require additional enrollment steps, which parents may not complete, leaving children uninsured.
Another concern: Many states are understaffed, which could lead to mistakes and make it more difficult for families to get the assistance they need to complete their eligibility verifications or transition to other sources of coverage.
What happens to both children and adults in low-income families will greatly depend on states’ renewal procedures, which can vary. Children are more at risk of losing coverage in states that charge premiums in their CHIP programs, that don’t provide 12 months of continuous Medicaid coverage for children and that process fewer than half of their renewals using existing data sources.
States can take steps now to minimize problems during the eligibility determinations, including using quarterly wage data and other sources to check enrollees’ incomes now, working with insurers to update Medicaid beneficiaries’ addresses in state records, conducting outreach campaigns to low-income families and establishing multiple ways to reach out to enrollees when action must be taken to renew coverage.