The pandemic has shed new light on children’s mental health across the nation. While the evidence is clear that even before the COVID pandemic there was a crisis in children’s mental health, the pandemic has further intensified the crisis, as highlighted by national pediatric provider groups in their declaration of a national emergency in child and adolescent mental health. Most recently, we saw extremely concerning data from the CDC finding that in 2021 almost 60% of female students and close to 70% of LGBQ+ students (as defined by the CDC) experienced persistent feelings of sadness or hopelessness. Even more concerning, nearly 25% of female students made a suicide plan and almost 25% of LGBQ+ students attempted suicide during the past year according to the CDC report.

It is abundantly clear that policymakers across the nation need to step up to address the crisis in child and adolescent mental health and also ensure they are not taking actions that could worsen the crisis. One such step is working to ensure a smooth unwinding of Medicaid’s continuous coverage requirement that minimizes coverage disruptions and ensures children don’t lose access to needed mental health services.

My colleagues have written numerous pieces on the Medicaid unwinding – all of which you can find on CCF’s unwinding page, here. However, for those of you who may be newer to the subject, here’s the gist—during the pandemic, the federal government provided states with additional Medicaid dollars on the condition that states maintain coverage for everyone enrolled in Medicaid, including children. This coverage certainty has meant families did not have to worry about their children losing their health coverage for important services, like mental health care, during the pandemic. It also means that today, Medicaid (alongside CHIP) covers over half of the children in the US. However, after passage of the Consolidated Appropriations Act at the end of last year, this requirement is now coming to an end. Accordingly, states may now start their regular Medicaid renewal processes and begin disenrolling individuals from coverage as soon as April 1st.

While some individuals may no longer be eligible for Medicaid and should be transitioned to alternative coverage options, millions of individuals and families – and children in particular – could get caught up in red tape and paperwork that means they could lose their health coverage even though they are still eligible. In fact, according to a government report, nearly 3 out of every 4 children losing their Medicaid coverage will remain eligible—that’s an estimated 3.8 million children that will still be eligible for Medicaid but could lose their health coverage nonetheless due to administrative barriers.

This is especially concerning for children with mental health needs who rely on Medicaid to provide access to comprehensive, affordable mental health care. According to CMS data, in 2020, nearly a third of non-institutionalized children ages 3 to 17 who were covered by Medicaid or CHIP had a mental, emotional, developmental, or behavioral problem. While access to mental health services for children can and undoubtedly must be improved in Medicaid and across payers, Medicaid’s EPSDT benefit provides comprehensive coverage for a broad array of mental health services for children including screenings, counseling and therapy, medications, inpatient and outpatient care, and home and community-based services. Gaps in care due to coverage losses could put children at increased risk of missing critical screenings and without access to needed mental health services. This is why if you care about children’s mental health, it’s important to also care about the unwinding of Medicaid’s continuous coverage requirement and what it could mean for children.

So what now? The good news is that there are states and Governors that are trying to be thoughtful as they approach the unwinding of Medicaid’s continuous coverage requirement such as extending continuous coverage periods for children to 12 months or longer (Oregon is now providing continuous coverage to kids up to age six). But there are also others who are not taking the same precautions, placing children’s coverage and mental health care at risk during the unwinding. Ultimately as highlighted in CCF’s latest report on child uninsurance rates, as we approach the unwinding, state leaders in all states must commit to working with community partners and taking specific actions like being transparent with data on eligibility denials and call center statistics and halting the process if large numbers of children and adults lose coverage for procedural reasons, call centers become overwhelmed, or other clear warning signs emerge.

We will continue to be monitoring this major coverage event closely and have unwinding resources including tips and best practices for states and stakeholders, communication resources and state-specific flyers on the CCF website here.

If you are experiencing mental health-related distress or are worried about a loved one who may need crisis support, you can contact the 988 Suicide & Crisis Lifeline for free and confidential 24/7 support at 988 (call or text).