The following is a statement by Joan Alker, executive director of the Georgetown University Center for Children and Families in response to Biden Administration letter to states requiring Medicaid ex parte renewal fixes and reinstatement of children and others impacted.
“Children are especially at risk during the current process of checking eligibility for everyone covered by Medicaid – the so-called Medicaid “unwind” of the pandemic-related continuous coverage protection. That’s because about half of children in the United States are now covered by Medicaid and CHIP. Eligibility levels for children are much higher than for adults, and children are also less likely to have access to affordable, employer-sponsored insurance. Federal researchers previously projected that three-quarters of children losing Medicaid coverage during the unwind will remain eligible – a far higher percentage than was projected to be the case for adults. Children are not expensive to cover, but they are regular utilizers of care; gaps in coverage are highly problematic.
A considerable number of states, it seems, have their eligibility IT systems programmed wrong and have been assessing children’s eligibility for continued Medicaid coverage by using a test based on their parent’s income eligibility standard, which in most cases, especially for parents of young children, is much lower than for children. States are required by federal law to make an “ex parte” determination of all individuals’ eligibility without requesting additional information from families that states already have access to.
In a typical state, Medicaid and CHIP eligibility is set at 255% of the poverty level but parents are covered up to 138% of the poverty level or considerably lower in a state that has not expanded Medicaid through the ACA (as low as 15 percent to 20 percent of the poverty level). Income eligibility is one important reason why children’s eligibility status differs from their parents, but it is not the only one – immigration status may be another.
We don’t know yet how many states have this problem but we expect at least half or more are likely impacted by this issue. A functioning ex parte process is essential to a smooth process for children. Some states, most notably Texas, are barely doing any ex parte determinations at all, which is a related challenge. While there are scenarios where adults could be impacted by this glitch, the reality is that children are undoubtedly the vast majority of those losing coverage inappropriately as a consequence.
I’m very pleased to see that the Biden Administration is taking strong and decisive action today to protect eligible children from losing Medicaid coverage. Their new guidance is clear; states that have this problem must stop the redetermination process immediately, reinstate those children and others that were inappropriately terminated and fix their systems before they resume the unwinding process for families. States that do not comply with federal law face significant financial penalties and that is made clear in the letter.
While this is not the only serious problem for children during the unwinding process, this is clearly a major systemic issue that is leading to eligible children losing coverage they need. The problem is likely more acute in states that have not expanded Medicaid to adults under the Affordable Care Act since the disparity in income eligibility between children and their parents is considerably larger.
We continue to urge CMS to require states to provide more disaggregated data by age and eligibility group which will help to identify these kinds of problems going forward.”