Report: Child enrollment in Medicaid, CHIP decreased by nearly 1M in 2018

Pediatrician with little girl
A new report looks at enrollment declines for children in Medicaid and the Children’s Health Insurance Program. (Getty/shironosov)

Child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) declined by nearly 1 million last year, a trend that’s not likely attributable to an improving economy, according to a new study. 

Researchers at the Georgetown University Health Policy Institute Center for Children and Families found that 912,000 children in 38 states lost Medicaid and CHIP coverage last year.  

Enrollment in the remaining states did increase by about 83,500—so nationwide, 828,000 fewer children were covered, a decline of 2.2%, according to the study. This follows years of flat or growing enrollment; between 2000 and 2016, enrollment declined only in 2007, by 1.1%. 

Edwin Park, a research professor at Georgetown and one of the study’s authors, told FierceHealthcare that while federal officials point to the economic rebound from the Great Recession as driving these trends, that doesn’t track with the data. 

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For example, in Utah, child enrollment in Medicaid and CHIP declined by 7.3% while unemployment increased slightly, making it unlikely that these children were all gaining employer coverage, he said. 

“It doesn’t really hold up when you look at a very straightforward comparison of economic indicators,” Park said. 

The report follows another from Georgetown last fall that indicated the number of uninsured children ticked up in 2017 for the first time in 10 years. In that study, Park and the other researchers flagged issues like the rhetoric around immigration as bigger factors than an economic upswing. 

Park said the new data strengthen the case that factors such as immigration status, the repeal of the individual mandate and the fallout from the repeal and replace discussion are driving the enrollment declines. 

“I think we have a little more confidence that the factors that we pointed to are some of the key drivers,” Park said. 

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However, the significant variation between states suggests that while national trends are playing a central role in the declines, individual trends for state populations are also crucial drivers.  

State changes to their Medicaid programs, for example, can alienate eligible families, Park said. Programs such as work requirements that mandate beneficiaries regularly prove eligibility can push people who would be eligible out of the program as well. 

Georgetown’s report also identifies several strategies policymakers at both the state and federal levels could adopt to mitigate the declines. For one, investing more resources in outreach and enrollment support is a crucial tool, especially to reach families who may not connect with government programs on their own. 

Streamlined enrollment processes such as automatic renewal and a 12-month continuous eligibility option can also be valuable to prevent people from dropping out, according to the report. 

“We go through are some of the steps that could be taken to make it easier move in the direction of providing a welcome mat for eligible families,” Park said.