Child Enrollment in Medicaid and CHIP Slips Again

We continue to closely monitor the trends in child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) following our report on the precipitous enrollment decline in 2018. As of March 2019, overall child enrollment in Medicaid and CHIP was down an additional 41k children in the first quarter of 2019. However, the national aggregated data masks the problem. Enrollment gains of 131k children in 22 states offset the decline of 173k children in 29 states.

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In the first quarter of 2019, six states – California, Florida, Illinois, Massachusetts, Missouri, and Texas – experienced enrollment declines of more than 10,000 children each. While the overall national percent decline is a modest .07%, nine states – Florida, Idaho, Illinois, Kansas, Massachusetts, Minnesota, Missouri, New Hampshire, and Vermont – have seen percentage declines of at least 1 percent. This list is topped by Idaho with a 4.3 percent enrollment decline in the first quarter, followed by Massachusetts with a 2.3 percent decline.

The enrollment decline continues to be concentrated in a quarter of the states. Since December 2017, enrollment has decreased by more than 1 million children in 37 states. In the 15-month period between December 2017 and March 2019, 13 states have either experienced enrollment declines of greater than 50,000 children or enrollment declines of more than double the national average rate of 2.3 percent. Of note, Illinois, Missouri, and Texas appear in both those groups. 

70 percent children who have lost Medicaid/CHIP coverage since December 2017 live in seven states.

Over 70 percent of the decline in the number of children enrolled over the 15-month period (from a baseline in December 2017 through March 2019) is concentrated in seven states – each of which experienced declines of greater than 50k children. These states include: California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas. It’s worth noting that the enrollment declines in Ohio and Tennessee may be moderating given that both states experienced increased enrollment in the first three months of 2019. 

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Nine states have percentage enrollment declines since December 2017 of more than double the national average of 2.3 percent.

Missouri tops this list with a 15-month enrollment decline of 10.7 percent, followed by Idaho where enrollment has dropped 10.5 percent. Also included in this group are: Illinois, Massachusetts, Mississippi, Tennessee, Texas, Utah, and Wyoming.

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As we get closer to having the first look at 2018 child uninsurance data when the American Community Survey is released in early fall, we continue to anticipate that the child uninsured rate will increase once again. If it does, it will be another blow to the nation’s historic success in covering children. 

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

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