National Decline in Child Enrollment in Medicaid and CHIP Slows but Steep Declines Continue in Problem States

In the first four months of 2019, overall child enrollment in Medicaid and CHIP dropped by 122,000 children with declines in 31 states offset by gains in 20 states. As noted in previous blogs and this report, the largest declines are occurring in a handful of states.

States with the Largest Percentage Decline – In these five states, the percentage decline in child enrollment for the 16-month period since December 2017 is at least two and a half times the overall national average of 2.5 percent:

  • Missouri experienced the largest percentage decline in enrollment – 12.1 percent – between December 2017 and April 2019. In the first four months of 2019, enrollment dropped by almost 20,000 more children – bringing the total decline to over 75,000 for the 16-month period.
  • Idaho child enrollment fell by 10.1 percent – nearly 22,000 children – over the 16-month period.
  • Utah has the third largest percentage decline of 8.1 percent with 17,000 fewer children enrolled.
  • In Tennessee, although child enrollment increased by 30,000 in the first four months of 2019, the overall enrollment decline since December 2017 still stands at 7 percent.
  • Louisiana moved into the fifth place with a 6.4 percent drop. More than 47,000 children have lost Medicaid and CHIP there since December 2017.

States with the Largest Decline in the Number of Children Enrolled – Three of every five children (60 percent) who have lost Medicaid or CHIP enrollment since December 2017 live in these five states:

  • Texas continues to have the largest number of children losing Medicaid and CHIP coverage with nearly 215,000 fewer children enrolled in April 2019 compared to December 2017 – a 6 percent decline.
  • California’s enrollment has dropped by nearly 187,000 children for a 3.6 percent decline.
  • Florida has disenrolled the third largest number of children – almost 97,000 children or 3.8 percent.
  • In Illinois, almost 83,000 children fewer children are enrolled in Medicaid or CHIP compared to December 2017 – a 5.8 percent decline.
  • Missouri has seen a decline in child enrollment of over 75,000, giving it the distinction of being the only state on both these lists.

The concentration of enrollment losses in a quarter of the states dispels the counterpoint that the enrollment decline is the result of favorable economic times. There is no evidence that the economy is five times better in Missouri than it is at the national level. Whether the causes are the chilling effect of hostile immigration rhetoric or administrative red tape barriers to enrollment and renewal, it won’t be long until we know the impact on our nation’s success in covering children. In September, the Census will release top line data on the number and rate of uninsured children which will help us better understand the effect of the Administration’s efforts to undermine the country’s health care safety net for children and low-income families.

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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