HHS tells states to do more to protect kids after millions lose Medicaid coverage

The Biden administration is calling on states that have dropped the highest numbers of children from Medicaid to take advantage of numerous federal policies to ensure families can regain coverage and don’t fall through the cracks.  

According to federal data released Monday, nine states accounted for about 60 percent of the decline in children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) from March through September. 

“State policy choices have real consequences for children and families,” the Department of Health and Human Services (HHS) said in a statement Monday. “States that take up proven flexibilities and strategies from the Centers for Medicare & Medicaid Services (CMS) are better able to protect kids’ coverage — especially when the state has also expanded Medicaid.” 

For example, HHS said the 10 states that have not expanded Medicaid have disenrolled more children than all the 41 expansion states and D.C. combined, largely because expansion states have adopted more flexibilities to help children reenroll. 

In total, about three million kids have lost Medicaid coverage since states began “unwinding” pandemic-era coverage in April, according to the Georgetown University Center for Children and Families. 

In letters to the governors of Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas, HHS Secretary Xavier Becerra said there have been more than 400 options put forward to make coverage renewals easier for people. 

“I urge you to ensure that no eligible child in your state loses their health insurance due to ‘red tape’ or other bureaucratic barriers during the Medicaid enrollment process,” Becerra wrote. 

Before the pandemic, people churned in and out of Medicaid for various reasons. Participants lost their coverage if they earned too much or didn’t provide the information needed to verify their income or residency. 

But during the public health emergency period, income changes or missed paperwork didn’t matter. If someone was enrolled in Medicaid in March 2020, or if they became eligible at any point during the pandemic, they remained eligible the entire time. 

As a result, Medicaid enrollment grew more than 30 percent and covered more than 90 million people.  

But Congress ended those protections, and states have been able to reassess eligibility and kick people off Medicaid rolls since April. 

When the Biden administration allowed states to begin “unwinding” pandemic-era Medicaid coverage, officials estimated about 15 million people would lose coverage.  

Since the process started April 1, the U.S. is more than halfway to that mark. Most people have been removed for “procedural” reasons, such as missing or incorrect paperwork, or when the state has outdated contact information, even though they may still be eligible.   

According to experts and advocates at Georgetown, it’s hard to know how many of the children losing Medicaid and CHIP are becoming uninsured, but given high uninsured rates pre-pandemic, they said there’s reason for concern.  

Becerra noted that children’s eligibility thresholds are generally higher than those for adults, so many children who have been disenrolled may still meet Medicaid or CHIP eligibility requirements — “underscoring the need for states to take further action to prevent eligible children from falling through the cracks.” 

In August, HHS sent letters to state health officials in all 50 states and D.C., warning that many are failing to meet federal requirements about determining Medicaid coverage. It was the first time the agency publicly disclosed its oversight and enforcement priorities. 

The letters flagged three key areas of concern: high rates of procedural terminations, long call center wait times and call abandonment rates, and slow application processing. 

In September, the administration said half a million people were wrongly kicked off Medicaid because of state system errors.