A new brief out this week from The Urban Institute confirms what we have suspected — the Medicaid continuous coverage provision has halted the increase in uninsured children that we saw during the Trump years. (As SayAhhh! readers know, no one can be involuntarily disenrolled during the federally declared public health emergency as a consequence of the Families First Act maintenance of effort provisions.)
The report also reinforces the importance of making sure states take the time to get it right when the public health emergency continuous coverage protections lift when we fear that millions of children are at risk of losing their coverage.
This report helps fill the data void left when the U.S. Census Bureau was unable to release American Community Survey for 2020 due to problems associated with the pandemic. As we’ve reported previously on Say Ahhh!, the National Health Interview Survey (NHIS) provides a first look at reliable national data on child uninsured rates and the Urban Institute brief relies on that data source to show the annual uninsurance rate among children declining from 5.1 percent in 2019 to 4.1 percent in 2021 — which translates to about 700,000 fewer uninsured children. Administrative data show that approximately 4 million more children were enrolled in Medicaid/CHIP in March 2021 than in March 2019. (CCF published the latest state-by-state data on increases in Medicaid/CHIP enrollment during the pandemic here.)
The authors credit policies put in place during the pandemic for stabilizing and even strengthening children’s insurance coverage and warn that without additional efforts, children’s uninsurance could once again increase later in 2022 or in 2023. The report states:
“The decline in children’s uninsurance observed on the NHIS is remarkable given the economic downturn, and if it is confirmed by other federal surveys, policymakers will have a better understanding of which policies can successfully mitigate coverage losses during recessions. But without federal and state actions to maintain the enhanced Marketplace subsidies and limit coverage losses when the continuous coverage requirement expires, children’s uninsurance could once again increase in 2022 and beyond.”
If that sounds familiar, it should as Tricia Brooks and I have been issuing red flag warnings about this for quite some time. As I explained in a blog, the nation’s Governors carry the bulk of the responsibility for making sure eligible children do not fall through the cracks and become uninsured when the PHE continuous coverage protections are lifted.
Governors don’t have to do it alone as they have CHIP administrative funding available to them to improve enrollment and retention among Medicaid/CHIP-eligible children and as documented in a new Georgetown CCF report, most of them are not fully leveraging this readily available source of federal matching funds to ensure children have a soft landing when the PHE ends. States have also been receiving an extra 4.34% bump in CHIP funding even though they have not been required to keep children enrolled in CHIP. Finally, a recent report from Kaiser Family Foundation found that states have received more than ample federal funds to compensate them for the costs of increased enrollment.
In addition to taking appropriate actions to keep children connected to coverage when the PHE ends, the Urban Institute researchers identify additional opportunities to maintain or expand children’s coverage including:
- Adopting continuous Medicaid/CHIP eligibility policies for children to avoid coverage gaps
- Expanding Medicaid to parents in nonexpansion states to further support family coverage
- Fixing the “family glitch” to improve coverage affordability for families
All of these are good ideas – and we should learn from this silver lining of the pandemic and ensure that a huge spike in uninsured children and families is NOT what happens when the public health emergency lifts.