Georgetown University Center for Children and Families (CCF) has sounded the alarm bells for more than a year warning that without strong state leadership and careful attention, millions of children, parents, disabled people and others eligible for Medicaid could be erroneously disenrolled for procedural reasons. Children are far more likely to lose Medicaid and CHIP coverage due to red tape and other procedural reasons, such as missed mail notices, than changes in eligibility. Federal estimates project that 3 out of 4 children disenrolled from Medicaid will remain eligible with an even greater share of children of color expected to inappropriately lose Medicaid coverage. As CCF experts monitored the unwinding, worked with stakeholders, and made recommendations to improve the unwinding process, we hoped for the best but prepared for the worst.
Enter Arkansas. As an Arkansan myself, I feel compelled to share that 25 years ago then-Governor Mike Huckabee championed children’s health coverage expansion in Medicaid through ARKids First (now called ARKidsB), which ushered in a significant improvements in child health coverage driving the child uninsured rate from close to 20% in 1996 down to single digits in recent years. This was quite an accomplishment for a state one of the highest rates of child poverty and was a source of pride for many of us Arkansans working diligently to make our state a better state to raise a child. Subsequent improvements over the years also aimed to cut red tape, minimize loss of coverage for procedural reasons, and keep children covered.
My, how times have changed.
Fast forward to 2023, with Governor Sarah Huckabee Sanders at the helm and a legislature that voted to fast-track disenrollments. Last month, Arkansas disenrolled more than 72,000 people from Medicaid or CHIP, about 80% of which were procedural closures. In contrast, Arizona, a state that also prioritized redeterminations for individuals it considered most likely to be ineligible for coverage, reported that the majority of individuals (80%) remained eligible and maintained their Medicaid coverage. Children made up 40% of the cases closed in Arkansas but the Governor doesn’t even acknowledge children in her Wall Street Journal op-ed patting herself on the back for quickly removing Arkansans from Medicaid. It doesn’t seem to bother her that many of these children remained eligible for Medicaid but lost it due to red tape.
Arkansas’s numbers also offer a rare glimpse into what’s at stake for infants and toddlers during the unwinding. The state reported that more than 3,300 very young children in Medicaid’s newborn category were disenrolled in April, who could become uninsured quickly if they don’t re-enroll or access other available coverage. Children in the “deemed newborn” eligibility category are automatically eligible and enrolled if their mother was covered by Medicaid or CHIP when they were born. States must determine eligibility for any other Medicaid eligibility category before terminating coverage (in this case that would normally occur on the child’s first birthday). Almost all deemed newborns should remain eligible for Medicaid or CHIP by age one. (A 2020 analysis by Kay Johnson suggests the deemed newborn enrollment was not working as intended well before the pandemic, based on data showing troubling gaps in infant coverage during their first year.)
Since federal coverage protections kept Medicaid enrollments in place on or after March 18th, 2020, many of the Arkansas children losing “newborn” coverage may be as old as three. But to be clear: Arkansas’s data isn’t showing children who successfully moved to other Medicaid categories, they are only showing closures. Most of the 3300+ children in the newborn closed case category are likely to remain eligible for ARKids First. And there are likely many more infants and toddlers among the 29,000 children who lost Medicaid or CHIP outside this narrow eligibility category.
Nobody should experience a period of uninsurance that can be prevented. I’m upset that any Arkansan still eligible for coverage lost it due to red tape, inadequate communication or other administrative barriers. But 3300+ infants and toddlers in one month is especially hard to stomach. The first three years of a child’s life mark an especially time-sensitive period of rapid early brain development that lays a foundation for lifelong success. Our brains can change throughout life, but capacity to adapt decreases significantly after the first few years.
Without insurance, infants and toddlers risk missing check-ups that monitor developmental progress and help ensure children with delays or other conditions can access needed care as early as possible. Recommended checkups are more frequent in a child’s earliest years making any loss in health coverage even more troubling as uninsured children are more likely to go without needed health care. Well-child visits also offer the most comprehensive means to reach and support young children and their parents before kindergarten.
In 2021, then-candidate Sarah Huckabee Sanders proclaimed:
“No child should ever be trapped in a life of poverty and despair, and as governor, I will lead a coalition of political, business, and faith leaders in an effort to make sure no child in our state ever goes hungry and has access to affordable healthcare.”
Governor Sanders should live up to her promise and show some leadership by pausing disenrollments. Then the state can take the time needed to keep its historic commitment to making sure eligible, low-income children in Arkansas get the health care they need to succeed.
[Editor’s Note: This is the 33rd blog in the Unwinding Wednesday series. For more information, visit our PHE Unwinding resource page where you’ll find other blogs in this series, reports, webinars and the 50-state tracker.]