The window of opportunity to make procedural or eligibility systems changes is quickly narrowing as states anticipate the lifting of the continuous enrollment requirement. (Photo: Shutterstock)
In the wake of job losses and reduced income during the pandemic, about half of the nation's children are enrolled in Medicaid or CHIP. Many of them are at risk of losing this insurance if a federal continuous coverage requirement ends in 2022, perhaps as early as April.
"Parents and millions of other adults will also have their Medicaid eligibility redetermined when the continuous coverage requirement lifts," according to a report from the Georgetown University Health Policy Institute. "Many adults whose income has gone up will become eligible for subsidized coverage through the federal and state marketplaces. Children will suffer if their parents and caregivers lose coverage during this transition. It is clear from past state experience that many parents will not successfully make the transition."
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Among the report's findings:
- At least 6.7 million children are likely to lose their Medicaid coverage and are at considerable risk of becoming uninsured for some period of time.
- When this mass eligibility redetermination happens, the outcomes will vary enormously for children depending on where they live and how well their states handle the transition.
- Children could lose coverage in one of two ways: they could become eligible for another public coverage program (most likely CHIP) and get lost in transition, or they could remain eligible for Medicaid but still lose their coverage for procedural reasons.
The Centers for Medicare & Medicaid Services is seeking feedback to develop a more comprehensive access strategy in its Medicaid and CHIP programs.
"Medicaid and CHIP provide essential health coverage for over 80 million individuals and families," CMS Administrator Chiquita Brooks-LaSure said. "Ensuring every eligible person can access the coverage and care to which they are entitled is a foundational principle of health equity and our work at CMS. We invite interested stakeholders and individuals with lived experience to join us in this mission, starting by responding to the request for information."
The window of opportunity to make procedural or eligibility systems changes is quickly narrowing as states anticipate the lifting of the continuous enrollment requirement. System changes can take weeks or months to program and test, and states may be restricted from hiring eligibility or call center staff or taking other steps to expand capacity until the date for the 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 how the lifting of the disenrollment freeze is impacting low-income children and families," the report concluded. "States should voluntarily or be required by the federal government to post their plans for resuming routine operations, as well as key performance data needed for monitoring and oversight. States should also increase CHIP funding for outreach and enrollment efforts.
"Additionally, if a large share of disenrollments occurs due to procedural reasons, states should pause and refine the state's plan or boost workforce capacity to make sure that eligible children are not losing coverage inappropriately. Without careful attention, the number of uninsured children in the nation could rise very rapidly."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
