There was a “precipitous drop” in the number of kids enrolled in Medicaid and the Children's Health Insurance Program (CHIP) – likely due to the elimination of the Affordable Care Act's individual mandate and reduction in communication outreach efforts, but also maybe because many families' incomes grew enough in the strong economy to get bumped out of the government programs.

Enrollment fell by nearly 600,000, to 35.4 million children in the first 11 months of 2018, according to U.S. Centers for Medicare and Medicaid Services data. Speculation by state officials for the underlying causes of the drop was across the board, posted in an article on Pew Trust's Stateline blog.

“I'm sure Idaho's strong economy is playing a role,” enabling families to leave public health programs, guessed Niki Forbing-Orr, spokeswoman for the Idaho Department of Health and Welfare. Idaho recorded one of the largest percentage drops (6.7 percent).

“While it's hard to pinpoint, the economy has improved in this state, and that would be a reasonable factor,” said Matt Westerfield, communications officer for Medicaid in Mississippi, another state with a large percentage drop (5.8 percent).

State officials in Texas and California speculated the same thing – more families buoyed by strong economic growth was likely a main reason why those states posted the biggest drop in total numbers, by 134,000 and 130,000, respectively.

However, Missouri officials believe it's the Republicans' fault on the federal level why the Show-Me State had the largest percentage decrease of enrolled kids in the first 11 months of 2018 at 8.1 percent, or 50,505 kids.

“In a letter to legislators this week, Patrick Luebbering, director of the family support division of the Missouri Department of Social Services, cited federal actions as one of the causes of the decline, including the Trump administration's cuts in services to educate and assist consumers enrolling in health insurance,” Stateline's blogger writes. Luebbering “also pointed to Congress' repeal of fines for people who failed to enroll in health insurance.”

Other factors that could have contributed to the enrollment drop include states unable to reach beneficiaries to alert them it was time to re-enroll; families moving to another state; changes in state data systems and illegal immigrants' fears of enrolling their children in public services for fear the family's status would be found out, resulting in deportation.

Reactions from health policy analysts and advocates were mixed about how children are ultimately being impacted by the drop in enrollment numbers.

“Essentially, we have done a fairly magnificent job in this country over the last 10 years in terms of kids insured,” said Dennis Johnson, head of policy and advocacy for the Children's Health Fund. “It's the reversal of that trend that has us worried. We see trouble on the horizon.”

However, Heritage Foundation health policy expert Edmund Haislmaier said the overall decrease is relatively small – and that 35.4 million children were still enrolled as of November.

“You're talking about less than a 1.5 percent difference,” Haislmaier said. “I would find it hard to make even a molehill out of that.”

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What's behind the drop in enrollment in children's public health programs?

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