Medicaid Unwinding May Leave Millions of Children Without Coverage

A young child at a medical appointment (Photo: Getty Images Signature).

By: Protect Our Care

As we enter the 5th annual Medicaid Awareness Month, millions of children and families are at risk of losing coverage.

Protections put into place by Congress to keep people enrolled in Medicaid during the public health emergency will expire on April 1. States have up to a year to complete the “unwinding” process to determine who is still eligible for Medicaid coverage.

A record 91.8 million Americans rely on Medicaid or the Children’s Health Insurance Program (CHIP) for their health care, including 34.2 million children – or 54 percent of children in America. It is predicted that approximately 15 million people may lose their coverage due to the unwinding. Children and families in Texas, Florida, and other states that have not expanded Medicaid are particularly vulnerable.

Many of those who could lose coverage are eligible for coverage through the Affordable Care Act (ACA) or traditional Medicaid. States have the responsibility to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, and people with disabilities. The Biden administration is working hard to support states and to demand a fair process. However, to date, many states have not committed to taking common-sense measures to keep people covered.

By The Numbers

• Nearly 7 million Children Are Expected to Lose Medicaid/CHIP Coverage Due to Unwinding. Fifteen million enrollees, including as many as 6.7 million children, are expected to lose coverage during unwinding.
• More than 50 percent of Children Are Covered by Medicaid/CHIP. Nationally 54 percent of American children are covered by Medicaid/CHIP.
• 72 Percent of Children Will Lose Coverage Largely Due to Procedural Errors. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP but will lose coverage due to procedural errors. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations.
• Medicaid Unwinding Disproportionately Impacts Children of Color and Children in Rural Communities. 68 percent of Black children, 60 percent of Latino children, and nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders are enrolled in public coverage. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care.
• Half Of Non-Expansion States Each Have Over 1 million Children Covered By Medicaid. These states include Texas, Florida, Alabama, South Carolina, Mississippi, Georgia, Wyoming, Wisconsin, Kansas, and Tennessee. Texas and Florida are dealing with large amounts of staff shortages and increased enrollment applications making evaluations challenging and a lengthy process.

Nearly 7 million Children Are Expected to Lose Medicaid/CHIP Coverage Due to Unwinding. 91.8 million people are enrolled in Medicaid/CHIP as of November 2022. Since February 2020, enrollment has increased by over 20 million people. Fifteen million people, including as many as 6.7 million children, are expected to lose coverage during unwinding. This is largely due to economic conditions due to the pandemic, Medicaid expansion in Nebraska, Missouri, and Oklahoma, and the federal continuous coverage provision that began in December 2020. Continuous coverage provided a 6.2 percent increase in federal Medicaid match rate to states to keep Americans enrolled without having to re-enroll each period.

More Than 50 Percent of Children Are Covered By Medicaid/CHIP, Most Are From Marginalized Communities. Nationally 54 percent of American children are covered by Medicaid/CHIP. These children are largely Black or Latino or live in rural areas. Currently, 68 percent of Black children and 60 percent of Latino children are enrolled in public coverage, as well as nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care. Children of color are more likely to experience churn or gaps in coverage than their white counterparts, due to parents of color being more likely to work low-wage jobs that are less likely to offer coverage.

Millions Are Expected to Lose Coverage Due To Red Tape Barriers During Re-Enrollment. Starting April 1st, states may disenroll ineligible people from Medicaid. Millions of people are expected to lose coverage due to either income increases making them ineligible or red tape barriers in re-enrolling that will prevent people from accessing coverage. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations. Children of parents who hold part-time, hourly, or seasonal jobs are more vulnerable due to the slight variations in income throughout the year that could cause changes in their eligibility. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP but will lose coverage due to procedural errors.

Texas And Florida Are Among 10 States That Refuse to Expand Medicaid. Half of non-expansion states, Alabama, Mississippi, Florida, Georgia, and South Carolina, each have over 1 million children covered by Medicaid. In Texas and Florida specifically, unwinding is going to be challenging with a lack of staffing to review the millions of cases in each state and increase in Medicaid applications. Texas is short 300 eligibility advisors and has seen an increase of nearly 70 percent in enrollment applications compared to 2019. Meanwhile, due to similar staffing shortages and an influx of applications, Florida has been taking weeks to review applications, while other states can review an application in as quickly as a day.

Protect Our Care is dedicated to making high-quality, affordable and equitable health care a right, and not a privilege, for everyone in America. We educate the public, influence policy, support health care champions and hold politicians accountable. Visit here for more information on Protect Our Care.

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