New Data Find Troubling Decline in Child Enrollment in Medicaid and CHIP Continues in Many States

Several months ago, we began to highlight concerns over the declining enrollment of children in Medicaid and CHIP. Just last month we published a brief on the unusual decline, noting that child enrollment had dropped by nearly 1 million children in 38 states in 2018. Although overall national enrollment was up by close to 20k children in early 2019, 24 states experienced declines in enrollment totaling 130k children. These data exclude Arizona, the District of Columbia, and Tennessee enrollment as those states do not report child enrollment to CMS, which is the source of the state-level data.

The most troubling signs are in those states with large enrollment declines in 2018 that are continuing to drop in 2019. Topping the list of states on the watch list is Idaho, which experienced the largest enrollment decline — 11 percent — in the 14-month period from December 2017 through February 2019. Missouri remains in second place with a 9.6 decline in child enrollment. 

Although we have only two months of enrollment data in 2019, child enrollment in Florida and Texas has declined another 18k and 23k respectively. This means that Texas moves into first place with the largest decrease in children enrollment in Medicaid and CHIP, moving ahead of California. (For more on what’s causing the enrollment decline in Texas, listen to the remarks by Dr. Laura Guerra-Cardus of the Children’s Defense Fund-Texas.)

On a positive note, 18 states with declines in 2018 are in the positive column for the first two months in 2019. But 5 of the 13 states with gains in 2018 (Kansas, Minnesota, Nebraska, North Carolina, and South Carolina) have seen enrollment shrink in early 2019.

The administration and policymakers continue to point to the strong economy as to why children are losing coverage. And we agree that Medicaid is sensitive to changes in economic conditions. But while enrollment growth slows when the economy is improving, it is unusual for enrollment to decline. Most importantly, there is little evidence indicating that access to affordable employer-sponsored insurance has improved for low-income families.

If children are securing other coverage, there is no reason for concern but that does not seem to be the case. Given that the uninsured rate among children increased by a statistically significant number in 2017, when Medicaid enrollment was basically flat, we are likely to see the child uninsured rate increase again when the Census releases the 2018 American Community Survey insurance data later this year. Stay tuned to Say Ahhh! as we continue to closely track child enrollment in Medicaid and CHIP throughout 2019.

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.