Child Enrollment in Medicaid and CHIP Down 600k Children in 2018

pediatrician examining little boys neck

After CMS released October 2018 Medicaid and CHIP data, we reported that child enrollment was down by more than half a million children in the first 10 months of 2018. So needless to say, we were anxious to see the final November 2018 numbers, which were just released. In November 2018, child enrollment in Medicaid and CHIP dropped by another 86,000 children, bringing the total decline in enrollment in the first 11 months of 2018 to just short of 600,000 children or an overall decline of 1.7%!!!

In October, 32 states were showing declines in enrollment in 2018; that number grew to 36 states in November. Enrollment declined by 4% or more in five states (Missouri, Idaho, Utah, Mississippi and Ohio). (Click here for a state-by-state analysis but note that Arizona, D.C., and Tennessee do not report state-level data.)

States with the Largest Percentage Decline in Child Enrollment in Medicaid/CHIP 

December 2017 – November 2018

State Percentage of Enrollment Number of Children
Missouri -8.1% -50,505
Idaho -6.7% -14,580
Utah -6.0% -12,653
Mississippi -5.8% -26,402
Ohio -4.0% -47,502

Five states (Texas, California, Florida, Illinois, and Missouri) with the largest drop in number of children enrolled in Medicaid account for nearly three-quarters (73%) of the total decline of just under 600,000.

States with Largest Decline in Number of Children Enrolled in Medicaid/CHIP

December 2017 – November 2018

State Number of Children Percentage of Enrollment
Texas -134,428 -3.8%
California -129,959 -2.5%
Florida -65,151 -2.5%
Illinois -55,640 -3.9%
Missouri -50,505 -8.1%
Total -435,683

The overall percentage decline in 2018 in Medicaid and CHIP enrollment of 1.7% may seem modest. But consider this – in 2017, the number of uninsured children increased by 276,000 to just over 3.9 million, reversing a decade of progress in covering children as highlighted in our annual uninsured kids report. In that same year, Medicaid/CHIP enrollment increased by 42,000 children. If we were to add 600,000 children to the uninsured roles, it would increase the total number of uninsured children by 15%.

Now to be fair, some of these children may have gained coverage through other sources. But we know that low-income children are much less likely to have access to affordable employer -based insurance and are much more likely to depend on Medicaid/CHIP to access health care. As I noted in the previous blog, only 26% of children in families with income under 250% FPL had employer-based coverage compared to 77% of children in families with income above 250% FPL in 2017. What the enrollment data show is that about 349,000 fewer children were enrolled in Medicaid/CHIP in 25 states with eligibility levels below the national median of 255% FPL compared to 25 states with eligibility levels above 255% FPL, where the decline in enrollment is 293,000.

If you were to simply apply the most recent estimates that 57% of uninsured children were eligible but not enrolled in Medicaid and CHIP, then as many as 340,000 more children could show up as uninsured when we get 2018 data from the American Community Survey (ACS) in September 2019.

I know. There are a lot of numbers here to absorb but there is a clear bottom line. If Medicaid and CHIP enrollment are going in the wrong direction, then there is strong reason to believe that the rate of uninsured children will again increase when the 2018 ACS data is released this fall.

Is it a coincidence, that after a decade of gains, we started to see a reversal in our nation’s progress in covering children in 2017 after the Trump Administration took a number of steps to undermine Medicaid and the Affordable Care Act? I think not. Many presidents from Clinton to Obama and even Bush (although he did veto CHIP reauthorization twice at the end of his second term) can claim success in providing America’s children with greater access to health care. It is becoming increasingly clear that President Trump may be the first president in recent memory to preside over an era where the nation loses its momentum on children’s health and the child uninsured rate increases.

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.