Child Enrollment in Medicaid and CHIP Remains Down in 2019

As of October 2019, the decline in child enrollment in Medicaid and CHIP held at .6 percent for calendar year 2019 based on the most recent enrollment data posted by CMS. While this is an improvement over the 2.2 percent decline in 2018, it still indicates that overall enrollment in Medicaid and CHIP is not helping to offset the increase in the number of uninsured children over the past couple of years.

In the first 10 months of 2019, child enrollment in Medicaid and CHIP was down by 224,000 children nationwide, or .6 percent, compared to a decline of 821,000 or 2.2 percent in 2018. (Note: enrollment is subject to retroactive adjustments and therefore data may not match previous reports or blogs.) Enrollment declines of nearly 443,000 in 34 states are offset by increases of 219,500 in 17 states with enrollment gains. In 2019 through October, three states (TN, VA, WI) have experienced enrollment gains of over 5 percent while three states (ID, MO, WY) have experienced enrollment declines of over 5 percent.

The top performing state is Virginia, where child enrollment growth of 5.4 percent since the Medicaid expansion was implemented in January 2019, reflecting the importance of the expansion’s “welcome mat effect” for children’s coverage. Honorable mention goes to Ohio, where enrollment grew by 2.8 percent YTD 2019 compared to a 4.7 percent decline in 2018, and Tennessee, with an enrollment gain of 5.3 percent YTD 2019 compared to a decline of 10.5 percent in 2018.

Despite a moderation in enrollment losses in 2019, it remains deeply concerning that more than one million fewer children were enrolled in Medicaid and CHIP in October 2019 compared to December 2017 at a time when more children are becoming uninsured. The Trump administration’s actions to wipe out investments in outreach and consumer assistance, implement hostile anti-immigrant policies, and promote stricter and more frequent reviews of eligibility have resulted in a reversal of the nation’s decade-long trend of positive coverage gains for children.

Over time, political leadership has been identified as a key element in our nation’s success in covering children. But when our country should focus on regaining enrollment momentum, the Trump budget strips $1 trillion dollars from Medicaid and CMS plans to propose new eligibility rules that will allow and encourage, if not mandate, states to conduct stricter and more frequent reviews of eligibility. It is clear that health coverage – even for children – is not a priority for this administration.

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