When the COVID-19 public health emergency concluded, it also marked the end of continuous Medicaid health insurance coverage for numerous vulnerable families in the United States. Shockingly, this process has resulted in the exclusion of 11.19 million individuals, including 4.61 million children, as of March 19. Unfortunately, many of these individuals are unaware that they are losing their coverage or that they might be eligible to regain it.
According to a state-by-state analysis conducted by the Center for Children and Families at Georgetown University, Utah currently holds the highest rate of “procedural” terminations. The analysis utilized national data reported to the Centers for Medicare and Medicaid Services. It revealed that in Utah, 94% of individuals who were dropped from Medicaid rolls lost their coverage without undergoing any determination of ineligibility. These individuals had not successfully completed the application or review process for various reasons.
Understanding the current state of eligibility assessments can be quite challenging due to the dynamic nature of the numbers. Each state is at a different stage of completion, making it a moving target. To comprehend the situation, it is essential to delve into the historical context.
Public health emergency begins — and ends
During the peak of the COVID-19 pandemic, families found themselves in the midst of both a public health crisis and an economic downturn. As unemployment rates soared and many lives were upended, the federal government implemented several measures to assist those facing financial instability. One such measure was the eviction moratorium, which aimed to provide relief to individuals struggling to make ends meet. Additionally, there was a continuous coverage provision for Medicaid recipients, ensuring that states could not terminate their benefits while the public health emergency declaration remained in effect.
The continuous enrollment period concluded in April 2023, however, the determination of eligibility has been conducted in phases through a process known as “Medicaid Unwinding.” The formal end of the public health emergency occurred on May 11, 2023.
All Medicaid beneficiaries were assigned an eligibility review month, with the unwinding process set to conclude on April 30. During this period in Utah, the Utah Department of Workforce Services was responsible for reviewing eligibility. In certain cases, eligibility could be determined without any action required from the enrolled individual or family. As a result, some cases were automatically deemed eligible or ineligible.
According to Kolbi Young, a spokesperson for Utah’s Department of Health and Human Services, cases can be terminated in two ways: through a finding of actual ineligibility or through a “procedural” termination. In the latter cases, the Department of Workforce Services sends letters to individuals, requesting additional information to determine their eligibility for Medicaid. To ensure that families who may be unaware of the process are reached, a public education campaign has also been launched.
Utah is expected to finish its unwind by the end of April, according to Young. The timeline remains on schedule.
Dropped, but maybe still eligible
According to Joan Alker, a research professor and executive director of the Georgetown University Center for Children and Families, there are various reasons why a procedural termination may occur. Families might choose not to be on Medicaid and fail to complete the necessary paperwork, or they might have found better employment opportunities that offer health coverage for both adults and children. However, Alker noted that it is less likely for children to have access to such coverage, especially in low-wage jobs.
In many cases, families may not have received the letter or might have had trouble understanding what steps they needed to take or where to seek assistance. Additionally, call centers established to provide support have been experiencing backlogs, long wait times, and delays, which is a widespread issue. There could also be instances where paperwork was not properly uploaded or deadlines were inadvertently missed.
According to Young, many individuals from Utah have experienced significant changes during the pandemic, such as moving, acquiring new contact information, or finding new employment. As a result, the eligibility staff has encountered difficulties in reaching out to these enrollees, and in some instances, they have not received any response. Young expressed uncertainty regarding the reasons behind this lack of communication, as some cases are still pending.
According to Alker, a report from the U.S. Department of Health and Human Services estimates that approximately 75% of the children who would be removed from Medicaid coverage during the unwind would still be eligible. She emphasizes that these children are losing their coverage due to procedural terminations and errors in the process. There are numerous ways in which the process can go wrong, leading to the loss of coverage for these children.
Utah is not the sole state experiencing a significant percentage of dropped coverage categorized as “procedural” termination. Other states with high shares include New Mexico at 93%, Washington, D.C. at 91%, and California and Alabama, both at 88%. These top five states reflect the impact of procedural disenrollments, which account for 70% of all cases in the United States. Such terminations affect millions of individuals, including children.
Are children being covered elsewhere?
The Georgetown center raises the question of what has become of the children who no longer have coverage. It is possible that some of them have transitioned to the Children’s Health Insurance Program (CHIP), which caters to low-income children but has different eligibility requirements. However, the whereabouts of the remaining children remain unknown.
Utah had a higher percentage of uninsured children even before the pandemic hit, surpassing the national average of 8.3% with a rate of 5.7%. However, the coverage during the pandemic managed to reduce the number of uninsured children in Utah to 6.1%, which is lower than the national average of 5.1%. This significant decrease in uninsured children in Utah is considered a major achievement for the state, particularly for low-income children. The impact of the pandemic has played a role in improving the coverage for these vulnerable individuals, marking a positive outcome for Utah.
According to Alker, it is crucial to consider children and adults separately when it comes to health coverage. This is because children are more likely to maintain their eligibility for Medicaid compared to adults.
Alker emphasized that it is unacceptable for children to be without health insurance, as it poses numerous challenges. The cost of medical care in the United States is exorbitant, making it impossible for most people to afford without insurance. This is particularly concerning for families with young children who require frequent visits to the doctor. While covering children is not expensive, their regular need for medical care makes it crucial for them to have insurance.
Babies and toddlers require extensive care as they grow, making regular well-child visits crucial. These visits are recommended for the youngest children to support their development and identify and address any potential issues. Ensuring that all children have insurance is important, but it becomes even more vital for the very young ones.
Alker emphasized that any lapse in healthcare coverage for children can quickly escalate into a family emergency. The financial strain caused by a mere accident, like a fall resulting in a broken bone, can be utterly devastating.
Health care coverage provides advantages not just for families, but for society as a whole. When children have good health, they thrive academically and personally. They are more likely to succeed in school and experience overall development. Moreover, those who had health insurance during their early years are more likely to graduate high school and earn higher incomes as adults. As Alker aptly stated, health care coverage brings immediate and long-term benefits.
Waivers enable continuous coverage
According to Alker, several states have either received or are currently pursuing Medicaid waivers in order to establish their own continuous coverage programs. Oregon was the first state to do so. Additionally, Alker mentioned that around twelve states are interested in completely reimagining the eligibility system for both children and sometimes adults. These states appreciate the benefits of reduced churn, a more stable and lower uninsured rate, and other advantages.
Coverage and duration differ across states in the waivers. In Oregon, for instance, a child who qualifies for Medicaid can remain enrolled until the age of 6. Similarly, children on CHIP also maintain their eligibility. After reaching this age, eligibility is reassessed every two years instead of annually. Washington and New Mexico have received approval for their waiver programs, ensuring continuous coverage. California’s waiver focuses on children aged 0-5, while Ohio targets those aged 0-3. Various states have their own unique formulas for implementing these waivers.
