A Troubling Sign: Half a Million Fewer Kids Covered by Medicaid and CHIP in 2018

Recent news of declines in enrollment in Medicaid, the growth in uninsured children and troubles with new eligibility systems in several states prompted me to take a closer look at the recently updated October 2018 Medicaid and CHIP enrollment numbers posted by CMS.

As we had feared, the data shows that in the first ten months of 2018, child enrollment in Medicaid and CHIP dropped by more than 500,000 kids. Between December 2017 and October 2018, 32 states experienced declines in child enrollment in Medicaid and CHIP; 20 of those states saw declines in both 2017 and through October 2018. (Click here for a state by state analysis, note that enrollment data is not reported for Arizona, D.C. and Tennessee).

Of course, you might say, the economy is in good shape so we would expect to see enrollment in public coverage declining. This is good news! A recent study by the Employee Benefit Research Institute indicates that the overall percent of private-sector employers offering health benefits increased in 2017 for the first time since 2008. And the ACS data reflects that the share of children covered by employer sponsored insurance did increase from 46.7 percent to 47.5 percent in 2017 (see Figure 3 in our uninsured kids’ report). But that wasn’t enough to offset declines in public coverage and in the direct purchase of insurance, including enrollment in Marketplace plans, which has continued to decline under the Trump Administration. And the number of uninsured children went up for the first time in many years. More than a quarter of a million children were uninsured in 2017 compared to the prior year. The CMS data heightens our concern that the number of uninsured kids will continue to rise in 2018. We’ll have to wait until the Census Bureau’s American Community Survey (ACS) releases 2018 data in September to see what’s happening.

Importantly, an offer of employer-sponsored health insurance doesn’t necessarily translate into coverage, particularly for low-income families, because it may not be affordable as employers shift more of the costs onto employees. Based on 2017 ACS data, only 26 percent of children in families with incomes below 250 percent of the federal poverty level had employer-sponsored coverage compared to 77 percent of children with family income above that level.

Our annual report identified nine states that experienced statistically significant increases in the rate of uninsured children in 2017. Seven of those states (Georgia, Florida, Massachusetts, Ohio, South Dakota, Texas, and Utah) show declines in Medicaid and CHIP child enrollment ranging between 2 percent and 5.3 percent in 2018.  This suggests that these states may be continuing to head in the wrong direction. Only South Carolina experienced an enrollment increase of just under 1 percent (Tennessee does not report enrollment data).

Needless to say, the precipitous decline in children’s enrollment in Medicaid and CHIP is extremely troubling. Most of our nation’s uninsured children are eligible for Medicaid or CHIP but unenrolled so that is why we must keep a close eye on what’s happening with enrollment. This could be a red flag that children are falling through the cracks but we may have to wait until the fall release of 2018 ACS data to see the full impact on children’s coverage rates. The increase in the uninsured rate for children and the drop in Medicaid/CHIP enrollment signal that children’s health coverage is clearly going in the wrong direction.

Tricia Brooks is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.