Insurance coverage

Millions of children are at risk of losing their health insurance coverage

The window of opportunity to make changes to procedural or eligibility systems is rapidly shrinking as states anticipate lifting the continuous enrollment requirement. (Photo: Shutterstock)

As a result of job losses and declining incomes during the pandemic, about half of the country’s children are enrolled in Medicaid or CHIP. Many of them risk losing that insurance if a federal requirement for continued coverage ends in 2022, possibly as early as April.

“Parents and millions of other adults will also have their Medicaid eligibility redetermined when the continuous coverage requirement is lifted,” according to a report from the Georgetown University Health Policy Institute. “Many adults with increased income will become eligible for subsidized coverage in the federal and state markets. Children will suffer if their parents and guardians lose their coverage during this transition. It is clear from the state’s past experience that many parents will not make the transition successfully.

Related: Delayed Health Care During Pandemic Takes Toll On Many Vulnerable Children

Among the report’s findings:

  • At least 6.7 million children are at risk of losing their Medicaid coverage and are at considerable risk of being uninsured for some time.
  • When this massive redetermination of eligibility takes place, outcomes will vary wildly for children depending on where they live and how their states are handling the transition.
  • Children could lose coverage in one of two ways: they could become eligible for another public coverage program (likely CHIP) and get lost during the transition, or they could remain eligible for Medicaid but lose coverage for procedural reasons.

The Centers for Medicare & Medicaid Services are ask for feedback develop a more comprehensive access strategy in its Medicaid and CHIP programs.

“Medicaid and CHIP provide essential medical coverage to more than 80 million individuals and families,” said CMS Administrator Chiquita Brooks-LaSure. “Ensuring that every eligible person can access the coverage and care to which they are entitled is a fundamental principle of health equity and of our work at CMS. We invite interested stakeholders and people with lived experience to join us in this mission, starting with responding to the request for information.

The window of opportunity to make changes to procedural or eligibility systems is rapidly shrinking as states anticipate lifting the continuous enrollment requirement. System changes can take weeks or months to program and test, and states may be barred from hiring eligible or call center staff or taking other steps to increase capacity until that the date of lifting of the public health emergency is certain.

“As of this writing, it is unclear that the public will have access to the information and data needed to assess the impact of lifting the opt-out freeze on low-income children and families,” concludes the report. “States should voluntarily or be required by the federal government to post their plans for resumption of routine operations, as well as key performance data necessary for tracking and monitoring. States should also increase CHIP funding for outreach and enrollment efforts.

“Additionally, if a large portion of unenrollment occurs for procedural reasons, states should suspend and refine the state plan or build workforce capacity to ensure eligible children do not lose their coverage inappropriately.Without careful attention, the number of uninsured children in the country could increase very quickly.

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