As we wait for the annual September release of key Census Bureau data on health insurance status,1 what are we at CCF expecting with respect to children? The data covers 2024, a year in which most states finished the process of Medicaid “unwinding” – a multi-year process during which everyone on Medicaid had their eligibility checked after the uninterrupted coverage provided by federal law during the COVID-19 public health emergency.
As regular readers of SayAhhh! know, we followed the Medicaid unwinding very closely as we were concerned that things would go wrong for children and families – and they did. We tracked Medicaid enrollment data and our final reckoning for the unwinding period was that there was a net decline of 5.53 million children covered by Medicaid.
We were particularly concerned about children because their eligibility levels for Medicaid and CHIP are so much higher than for adults that there was a much greater likelihood that they would lose Medicaid but still remain eligible.
They key question, of course, is where did these children go? The most obvious place for them to go if their families’ income rose was CHIP – but overall CHIP enrollment did not increase much during the unwinding period. To date, CHIP enrollment has risen by only 414,000 individuals as compared to pre-pandemic numbers.
If they moved to affordable, comprehensive employer coverage that would have been great! We shall see – we don’t expect a lot of movement in this direction since dependent coverage is very expensive as some employers, especially small businesses, don’t contribute much to the cost of family coverage. Some children may have moved to the Marketplace with or without their parents – indeed we heard this a lot anecdotally because parents were frustrated by their state’s inability to reenroll their child whom they believed to be eligible. Marketplace enrollment for children has gone up (just as for adults) – but we do not have income data for these children so we don’t know if they actually should be in Medicaid or CHIP.
Our main takeaway on the Medicaid unwinding was that state variation was huge — as the map below shows!!! Some states ran the extra mile quite literally to protect children by slowing down the process – looking at you Kentucky and North Carolina which took a 12-month extension for children and are still processing renewals. So, I would expect some states that had large Medicaid enrollment drops like Utah, Colorado and Texas to see a rise in their child uninsured rate but some states will not.
Nationally we expect the number of uninsured children to have risen between 2023 and 2024 – but probably not by a lot. The American Community Survey has been documented to undercount Medicaid compared to what we see in administrative enrollment data – and this tendency seems to have been amplified during the pandemic. And ACS will not necessarily provide insight into how many children had a gap in coverage over the course of the year.
But overall, we will learn if child coverage rates went in the wrong direction – and with storm clouds looming for far greater coverage losses due to enactment of the budget reconciliation law and the overall policy climate this would be troubling news indeed.
Georgetown CCF will be holding a webinar on Friday, September 12th at 1p ET open to all to share our rapid analysis of child coverage trends discerned from the new Census data. You can register for the webinar here.
- The Current Population Survey health insurance data is scheduled to be released on September 9th and the American Community Survey health insurance data is scheduled to be released on September 11th ↩︎