Based on the recent release of final August 2019 enrollment data by CMS, the decline in child enrollment in Medicaid and CHIP improved ever so slightly from a 3 percent decline in the 18-month trend from December 2017 to June 2019 to a 2.9 percent decline over the 20-month period through August 2019. At the same time, the number of states with an overall decline since December 2017 increased from 37 to 39 states. During a time when more children are becoming uninsured, it is disappointing that enrollment has grown in only twelve states since December 2017. After all, a majority of uninsured children are eligible but not enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
In our recent annual report on uninsured children, we highlighted that 15 states experienced statistically significant increases between 2016 and 2018 in the number or rate of uninsured children (AL, AZ, GA, FL, ID, IL, IN, MO, MT, NC, OH, TN, TX, UT and WV). So, we are doubly concerned about negative enrollment trends in these states. Since December 2017, child enrollment in Medicaid and CHIP has grown in only three of those states – Alabama, Georgia and Indiana. However, it is somewhat promising that enrollment improved in half of those states (AL, GA, IL, IN, OH, TN, TX, WV) in the two months since we last reported enrollment through June 2019 although these states still reflect negative enrollment trends.
As the map below shows, child enrollment in Medicaid and CHIP declined in 39 states between December 2017 and August 2019. Of those, 25 states have experienced enrollment declines at or above the national average of 2.9 percent – eight of which have declines that are at least double the national average.
- Three states have experienced double digit percentage declines in enrollment – Missouri (16%), Idaho (15.4%), and Wyoming (10.5%).
- Four states have experienced enrollment increases of at least four percent – Virginia (7.7%), Alaska (6.7%), Iowa (4.2%) and Wisconsin (4.2%).
We skipped reporting the enrollment trends in the month of July while we investigated a discrepancy in North Carolina data associated with a reporting error that has now been corrected. Although the 18-month trend reflected a .3 percent increase, with the adjustment and updated data, North Carolina shows a 2 percent decline over the 20-month period. There was also a retroactive adjustment to Florida data that contributed to the state’s growing decline that now stands at 4.4 percent.
Looking only at recent changes reflects how quickly enrollment can be impacted. For example, just in the two months between June and August 2019, we observed the following:
- Four states experienced declines of more than 1 percent of the state’s total enrollment – Idaho (6.2%), Nevada (4.4%), Montana (1.5%) and Wyoming (1.4%).
- Three states showed enrollment gains of at least 1 percent – Alabama (1%), Ohio (2.4%) and Louisiana (3.2%).
While the overall rate of decline in 2019 through August of .6% has slowed compared to the 2.3 percent decline in calendar year 2018, it is important that everyone concerned about child health continue to monitor their state’s enrollment data and advocate for policy and procedural changes to ensure that all eligible children are enrolled in Medicaid or CHIP. For ideas on what your state can do, check out our blog series on regaining enrollment momentum.