Kids lost coverage despite CHIP's promise
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Illustration: Maura Losch/Axios
The number of kids enrolled in Medicaid has decreased by more than 5.5 million in the last 18 months, and only a small percent of those losing coverage were enrolled in a sister program designed to be a safety net for uninsured children.
Why it matters: It illustrates how paperwork hassles, technicalities and differing state policies create significant coverage gaps among working-class families as states finish purging their Medicaid programs now that pandemic-era coverage requirements have ended.
The big picture: The Children's Health Insurance Program was designed to keep kids insured when their family makes too much to qualify for Medicaid but still might have trouble affording private health insurance.
- The Urban Institute in 2022 estimated that 57% of kids losing Medicaid in state unwindings would be eligible for separate CHIP coverage.
- Instead, CHIP programs have netted up about 9% — or 450,000 — of the population of kids who fell off Medicaid rolls since states started resuming eligibility checks in the spring of 2023, according to a Georgetown University Center for Children and Families analysis of state and federal data shared with Axios.
- Millions of other kids who were dropped are likely eligible for CHIP but slipped through the cracks due to paperwork issues or some states' failure to automatically transfer enrollees between the programs.
- There's no clear data yet on how many kids have transferred to private coverage, though kids' enrollment in Affordable Care Act marketplace coverage has increased this year.
What they're saying: "States are making choices ... about how easy it is to get from A to B," said Joan Alker, executive director of Georgetown's Center for Children and Families. "That's unquestionably reflected where we saw fewer transfers to CHIP than we expected."
Catch up quick: Like Medicaid, the criteria for CHIP programs varies by state. There are different income eligibility levels, and some states require recipients to pay monthly premiums.
- States can run CHIP separate from Medicaid or combine the programs for efficiency's sake. States can also expand Medicaid eligibility to more kids while still maintaining a separate CHIP program for kids from families with higher incomes.
The differences have left a patchwork of coverage options with significant gaps in the safety net.
- Enrollment in Connecticut's CHIP program increased by about 60% of the state's Medicaid enrollment decline.
- But other states lag far behind. Michigan saw only a 0.1% increase while Idaho's CHIP enrollment decreased between the start of Medicaid unwinding and February 2024.
Zoom in: Seven states weren't automatically transferring kids from Medicaid to CHIP when they had data proving eligibility, instead requiring families to return renewal forms and likely keeping many kids shut out of coverage, according to a survey conducted in March by Georgetown and KFF.
- A new federal rule that went into effect in June now requires states to seamlessly transition enrollees between Medicaid and CHIP when their eligibility changes.
- The rule also prohibits states from locking kids out of CHIP coverage when they don't pay premiums and ending waiting periods before kids can access CHIP.
Yes, but: While some kids move from Medicaid into CHIP, others move from CHIP to marketplace plans or their parents' employer-sponsored coverage.
- There's likely been more movement into CHIP coverage since unwinding began than the net enrollment numbers show because kids are also cycling out of the coverage, said Bruce Lesley, president of First Focus on Children.
The bottom line: The complex way Medicaid and CHIP coexist mean that the program seems to be working as intended in some states and not as well in others, said Jennifer Tolbert, director of state health reform at KFF.
- "Regardless of … the nitty-gritty details of the data, the fact is that the uninsured rate for children increased," she said, adding that policymakers and researchers need to look deeper into eligible children being kicked off Medicaid.
