As we continue to unpack the first round of unwinding data released by CMS a few weeks ago, it remains disappointing that there is not more data on children. As readers of SayAhhh! know, the stakes for children are very high with over half of the children in the country insured through Medicaid, and they are much more likely to remain eligible for Medicaid and be disenrolled inappropriately than adults. This is the primary reason why it is so important to have disaggregated data for children. If procedural terminations are high that suggests that many of these children should be remaining on Medicaid and are unlikely to have other sources of affordable coverage. And all of these issues are acutely important for families of color – for whom administrative churn is a greater risk.
Monthly data reports submitted to CMS by states are not required to include disaggregated data by age, however, most states likely have the information easily at hand. So, we are all relying on states to publish the data themselves to help determine how children and adolescents are faring during the unwinding process.
Currently, 14 states have posted partial unwinding data for children (AZ, AR, CT, KS, IN, MA, MN, MO, NY, OK, TN, VA, WI, WV). Of these, just four states (CT, KS, MO, and WV) have reported the number of kids disenrolled for procedural reasons. Oklahoma is reporting data on children procedurally disenrolled, but only for those in their “PHE-protected” group – not the entire Medicaid child population. Identifying the number of children who have coverage terminated for procedural reasons is incredibly important, as discussed above, since they are at high risk of becoming uninsured. Child-specific data can indicate where more effort is needed to ensure that eligible children maintain or are reenrolled in coverage. This is especially true in states that have not expanded Medicaid for adults as these states have a larger share of their Medicaid enrollment constituted by children. Last week, Heather Braum from Kansas Action for Children highlighted new data from Kansas (a non-expansion state) indicated that children are at significant risk of procedural disenrollment and explaining how critical this data is for all stakeholders: health plans, providers, navigators, and advocates.
Though CMS is not requiring states to report child-specific unwinding renewal data, states can and should make their data publicly available. It’s not a heavy lift and is a first step toward protecting eligible children from losing coverage. Take Missouri: the state just launched its unwinding data dashboard, which includes all of the required renewal outcome metrics from the CMS monthly reports, but also provides a breakdown of all of the renewal outcomes by eligibility group. West Virginia has taken an even easier approach, revising its published monthly reports to CMS to indicate renewal outcome data for kids right on the reports themselves, as shown below. Unfortunately, like most states, both states’ data show high rates of procedural disenrollment for children but it’s good they are being transparent about that fact so stakeholders can help keep eligible children covered. States with high rates of procedural terminations for children should strongly consider pausing these terminations to figure out what is going wrong. Are children being cut off alongside their parents despite remaining eligible? Is there a problem with the IT system? Are notices confusing to parents who have lost eligibility themselves – especially in non-expansion states where parent eligibility is so low?
Many states are still not releasing unwinding data by age. Another pathway (pun intended) to this information is a public records or Freedom of Information Act (FOIA) request or even an informal request to their state Medicaid agency. Idaho has released data that way. And a reporter from the Georgia Recorder last week received information from the state that approximately two-thirds of those terminated from coverage in June were children (63,481) and, sadly, most of these terminations were procedural.
With children across the country heading back to school, states and stakeholders have an important opportunity for outreach to children and families focusing on the need to check their coverage status. Child-specific unwinding data can indicate how the unwinding is affecting kids so far, can help indicate where targeted outreach to families may be needed, and may also help identify where there are systemic problems that need to be addressed. The stakes are high. Gaps in coverage are problems for anyone – but especially for children who, while not expensive, are regular users (or should be) of health care.
[Editor’s Note: This is the 41st 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.]