CCF, Pediatricians Urge State Leaders to Shield Children from Losing Medicaid Coverage

State-by-State Report Shows Medicaid Now Covers More Than Half of U.S. Children

This week we teamed up with our colleagues at the American Academy of Pediatrics to release a report and discuss the high stakes for children when the Medicaid continuous coverage protection expires. Medicaid and CHIP now cover 54% of children in the United States. Lisa Costello, MD, MPH, FAAP, a member of the American Academy of Pediatrics Committee on State Government Affairs and immediate past president of the AAP West Virginia Chapter, joined Tricia Brooks and me to discuss the report and focus on what states can do to shield eligible children from losing Medicaid or CHIP coverage and ensure a smooth transition for children moving to CHIP.

At the end of 2022, Congress acted to delink the end of the continuous coverage Medicaid protection, which started in March 2020, and the end of the federal COVID-19 public health emergency declaration and states are now moving forward (at different paces) to check eligibility for everyone on Medicaid – a mammoth task at a time when states are short staffed. Terminations will begin in some states as soon as April 1st. States have until May 2024 to complete this process.

Why are so many children covered by Medicaid today? The Medicaid continuous coverage pandemic protection is a key factor but there are also reasons which reflect longer term trends. Children remain the poorest group in our society and Medicaid/CHIP income eligibility levels for children are significantly higher for children than adults – on average two and a half times the poverty level. Employer-sponsored coverage for dependents is often non-existent or simply too expensive for dependents.

Overall Medicaid and CHIP enrollment has increased by 28 percent between March 2020 and August 2022 (the latest data available in time to analyze for the report). For children, while total enrollment growth has been lower at 17.5%, today 54% of all children in the U.S. are covered by Medicaid or CHIP. In thirty states and DC, the majority of children are now covered in Medicaid/CHIP and in ten states (New Mexico, Louisiana, Mississippi, Florida, Alabama, West Virginia, Oklahoma, Georgia, South Carolina, and Indiana) and DC, more than 60% of children are covered by Medicaid/CHIP (see map). While we are unable to disaggregate this data source by race, this is likely an even higher percentage of Black and Latino children covered by Medicaid.

Approximately 38 million of these children will have their coverage checked over the next year, and millions are likely to lose it in the process – sometimes because they are no longer eligible due to a family’s income having increased or a child turning 19 – but far more likely because of administrative errors. Because children are primarily covered through Medicaid/CHIP and not the federally subsidized marketplace, governors and state policymakers really hold the cards when it comes to keeping eligible children connected with their public health coverage. Federal researchers have estimated that 72% of children losing Medicaid will remain eligible.

Medicaid has become the backbone of our health system for children today and its spine was stiffened by the pandemic continuous coverage protection, which prevented the churn that we normally see – especially in states that went into the pandemic with higher child uninsured rates.

For states that have not expanded Medicaid, the majority of pandemic Medicaid enrollment growth is attributable to children – with Georgia leading the way (69% of Georgia’s Medicaid enrollment growth = children). In these states, because they cover far fewer adults, the Medicaid unwinding will impact primarily children, new mothers and very poor parents.

State leaders in all states—and especially in the 11 non-expansion states– must put the needs of children front and center in their unwinding plans. If states do not do a good job, we could easily see the number of uninsured children double.

[CCF hosted a webinar to release the report and discuss the impact of the Medicaid continuos coverage protection on children with the American Academy of Pediatrics and other stakeholders. You can view other CCF webinars on this topic here.]

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.