The number of children without healthcare coverage could increase come next year as a congressional emergency provision to deal with the COVID-19 pandemic ends.
The Families First Coronavirus Response Act that legislators passed in March 2020 will most likely expire in January, raising concerns that the approximately hundreds of thousands of children who gained coverage under the legislation might be taken off the rolls.
The American Community Survey by the U.S. Census Bureau reports that the number of children under 19 without health insurance fell to 3.9 million in 2021, or about 475,000 fewer children without coverage than in 2019, thanks to greater enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) under the public health emergency.
The data crunching was overseen by Joan Alker, the executive director of Georgetown University’s Center for Children and Families. In her blog, "Say Ahhh!," Alker called the surge in Medicaid enrollment a “silver lining for children in a bleak pandemic.”
Alker wrote that Census data “tend to undercount Medicaid—and recent enrollment data from the federal Centers for Medicare and Medicaid Services [CMS] finds that more than half of the nation’s children (40.625 million) are enrolled in Medicaid or CHIP and that child Medicaid/CHIP enrollment increased by 5.6 million between February 2020 and May 2022.”
As of May 2022, over 40.6 million children were enrolled in either Medicaid or CHIP, representing 45.7% of the total enrollment for those programs, according to CMS.
“This is the first comprehensive look at the pandemic period from ACS since 2020 data was not released,” Alker writes. “We can’t wait to dig in and explore these trends more deeply in our annual report on children’s health insurance trends which we expect to release in mid-November.”
Both Medicaid and CHIP are joint federal/state programs, and Alker points out that the chances of children continuing to be covered by Medicaid depends somewhat on where they live.
“My hunch is that states that have large numbers of uninsured children and are prone to using administrative barriers to keeping eligible children out of Medicaid/CHIP or dropping them at renewal will see some of the largest improvements in their child uninsured rates,” Alker writes. “Looking at you Texas, Georgia, Florida.”
The uninsured rate for children in Texas declined from 12.7% in 2019 to 11.8% in 2021. That reflects an increase in the number of children covered by Medicaid alone or in some combination with other benefits packages from 36.4% in 2019 to 38.4% in 2021.
Shifting from PHE back to normal won’t be as easy as flicking a switch. As Fierce Healthcare recently reported, state insurance regulators in Florida believe it could take up to one year to fully finish redetermining eligibility for their Medicaid populations after the COVID-19 public health emergency ends. That makes patient advocacy groups nervous.
Jodi Rey, the executive director of Florida Covering Kids & Families, a not-for-profit organization affiliated with the University of South Florida, said she’s frustrated because state officials haven’t unveiled their plan for the transition. “Currently we have over 5 million people on Medicaid, so this is absolutely concerning,” Rey said. “We’re really concerned with the seamlessness of being able to move enrollees from CHIP and Medicaid into the Marketplace. It is currently not a seamless process in Florida.”