Medicaid Enrollment is Down by Five Million Including Two Million Children

We’ve been tracking changes in Medicaid enrollment for everyone including children. Sadly, today our tracker of net child Medicaid enrollment losses went over two million nationwide and exceeded five million for adults and children combined. And states are not done yet! According to KFF’s recent estimates, we’re only about one-third of the way through the process. Texas and Florida account for one-third of the two million children and any moment now we should get August numbers in from Texas, which will undoubtedly add hundreds of thousands more children to the number.

These numbers may be different from some you’ve seen elsewhere because they are NOT the number of disenrollments  — which is a considerably larger number. Net enrollment accounts for newly enrolled people or those who were disenrolled but reenrolled or were reinstated because the state made an error such as the recent auto-enrollment or “ex parte” glitch. In August the Biden Administration identified a flaw in many state Medicaid systems that was causing children (and some adults) to lose coverage inappropriately; this error is in the process of being rectified. It is not known precisely how many children were impacted.

CMS released updated data today, which is what sent our tracker over two million. CMS data is as of July; we use these numbers where we cannot get data directly from states. So some of our numbers are more recent and that is how we end up with a higher number than CMS – since losses have been accelerating in recent months.

Two million children losing Medicaid is a very high number but it is an underestimate because of data lags between when states report unwinding disenrollments and when they report their current enrollment. Also, net figures reflect movement in and out of Medicaid, so more children are likely experiencing gaps in coverage. To put the two million decline in context, in 2022 there were 3.9 million uninsured children according to the U.S. Census Bureau’s American Community Survey.

The key question, of course, is where are these children going and how many of them are becoming uninsured or experiencing gaps in coverage. We may never have a great answer to that question but there are many reasons to be worried that a significant proportion of the two million children are experiencing gaps in coverage. Children are much more likely than adults to remain eligible for Medicaid – so that is why enrollment declines in Medicaid for kids generally portend a rise in the uninsured rate.

Last week my colleague Jade Little and I blogged about the troubling small percentage of children who are moving to separate CHIP programs (8.8%).  Our colleague Edwin Park analyzed recent data on movements to the marketplace with marketplace enrollment equaling only about 10% overall of those losing Medicaid (and this would likely be a considerably smaller percentage for children). Some children have employer-sponsored insurance but we don’t know how many (and note – having ESI doesn’t disqualify a child from enrolling in Medicaid if they remain eligible though it does for CHIP). But as data from the KFF Employer Health Benefits survey reinforces, employer-based family coverage is very expensive so the likelihood that low-wage workers have offers of affordable coverage for their children is low.

Assuming that half of those children losing Medicaid have other sources of coverage (which seems somewhat optimistic given the available data on where children are going) at least one million more children would be experiencing a period of uninsurance already and the unwinding process has quite a ways to go yet. Very sobering.

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.