Since the 2017 ACS data was released in September 2018, we have been concerned about the first increase in the number of uninsured children in a decade as highlighted in our annual uninsured children’s report. We became even more concerned as we watched the number of children enrolled in Medicaid and CHIP drop in 2018, as detailed in the report we released last week – Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again.

As we were researching the latest report, we got more troubling news in a new brief showing that the child participation rate in Medicaid and CHIP declined in 2017 for the first time since the participation rate was first measured by researchers at the Urban Institute. Participation rates estimate the percentage of children who are enrolled compared to uninsured, eligible children. Over time, the participation rate had steadily improved from 81.7 percent in 2008 to a high of 93.7 percent in 2016. This is a remarkable achievement considering that it was once widely accepted that participation in means-tested benefits could not reach a level comparable to universal programs such as Medicare.

However, in 2017 – the same year the number of uninsured children increased by 276,000 from 4.7 percent to 5 percent – the child participation rate declined to 93.1 percent. The decrease was considered statistically significant.

The Urban Institute report details the following:

• After ACA implementation in 2014, children’s and parents’ insurance coverage rose. But between 2016 and 2017, children’s coverage decreased, and parents’ gains stalled.
• Uninsured rates rose between 2016 and 2017 among both children and parents in states that have chosen not to expand Medicaid to low-income adults.
• Both children and adults remained much more likely to be uninsured in non-expansion states compared to expansion states.
• In 2017, 2 million children and 1.7 million parents were estimated to be eligible for Medicaid/CHIP but unenrolled.

As we noted in our latest report on the enrollment decline, there is negligible evidence that any economic factors have substantially increased access to affordable private or employer-based insurance (ESI) for low- to moderate-income families. In fact, even with a decade of economic growth, there has been a declining share of non-elderly people with incomes between 100 percent to 400 percent of the federal poverty level enrolled in ESI, according to the Peterson-Kaiser Health System Tracker. So, it is far more likely that children who are losing Medicaid and CHIP are falling through the cracks.

At a time when the economy is strong, the decline in child enrollment in Medicaid and CHIP in 2018, following an increase in uninsurance among children and a decrease in the participation of eligible children in Medicaid and CHIP in 2017, the critical question is whether children are moving to private coverage or becoming uninsured. This question won’t be answered definitely until the US. Census Bureau’s American Community Survey data is released this fall.

In the meantime, the Administration and states should not sit idly by. Our nation’s historic progress in covering children is at risk, and will only grow worse if no action is taken to ensure that eligible children are not losing coverage due to administrative barriers and red tape.