The Senate and the Biden administration must take steps, outlined below, to prevent massive health coverage losses in 2022 which will disproportionately impact Latino children and their families.
COVID-19’s disproportionate impact on Latinos is continuing to tragically demonstrate historical inequities in access to health care. Latinos are 1.6 times more likely to contract COVID, 2.5 times more likely to be hospitalized due to COVID, and 2.1 times more likely to die from COVID than people who are non-Latino and white.
Two programs—Medicaid and the Children’s Health Insurance Program (CHIP)—provide health care coverage for millions of Latinos, including families and children. Unfortunately, even before the pandemic, enrollment in Medicaid and CHIP was declining, especially for Latino children.
In fact, Latino children are 2.5 times more likely to be uninsured than are non-Latino white children and Medicaid is the primary source of health coverage for more than half of Latino children in the United States. Children with access to safety net programs like Medicaid have better birth outcomes, improved overall health, and are more self-sufficient as adults who can make both higher earnings and tax contributions.
But due to a useful provision in the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, enrollment in Medicaid has increased, reversing the downward trend. Under the FFCRA, so long as the federally declared public health emergency (PHE) remains in force, Medicaid beneficiaries are generally able to maintain health coverage. To partially offset the cost of covering additional people, states are getting a 6.2% increase in their federal match for Medicaid (this match is called the Federal Medical Assistance Percentages or “FMAP)”.
Medicaid is currently working as it should, as a bulwark that supports families, including during an unprecedented national emergency such as the pandemic. Yet, after the pandemic officially ends, the more than 17 million many Latinos who rely on Medicaid will become highly vulnerable to the loss of coverage and care. For this reason, members of the House of Representatives and the Biden administration are proposing requirements for states that will minimize the number of eligible people who will lose coverage for procedural reasons once states are allowed to restart Medicaid disenrollments in 2022.
The Build Back Better (BBB) legislation passed by the House severs the connection between Medicaid enrollment and the federal PHE. Under the BBB, states will continue to receive the 6.2% FMAP increase until April 2022, regardless of when the PHE expires. Then, beginning in April, states may resume disenrollment of Medicaid beneficiaries who have been determined ineligible. The bill also provides important guardrails to determine how a state should resume Medicaid disenrollment. The overarching goal is to reduce the number of eligible people who lose Medicaid because they missed a required step in the renewal process.
These updates to the statute benefit states, because they provide a more definitive timeline for restarting Medicaid disenrollment. They also support Medicaid recipients, because they may help to prevent disenrollment of eligible people.
But there is fly in the ointment: if the BBB is enacted as it currently written, nothing would prevent states from forfeiting the increases the government is offering (through FMAP) and instead just disenrolling people again without adhering to the new guardrails. This is more than a hypothetical concern: in Texas, where more than 1.5 million Latino children rely on Medicaid, state officials have publicly stated they are exploring this option.
This kind of move by states could trigger mass disenrollment of eligible individuals from Medicaid. For example, Utah suspended renewals for its Children’s Health Insurance Program (CHIP) at the beginning of the pandemic, but then, once the state resumed renewals, an unprecedented 41% of children in the CHIP program lost coverage, the vast majority (~89%) because of a procedural issue not because the state determined they were no longer eligible. Similar coverage losses have been seen in other states where renewals were temporarily suspended.
To prevent eligible Latino children from being improperly denied Medicaid, the Senate must pass the necessary guiderails included in the BBB legislation. They should also add language which makes clear that states must follow all standing statutory requirements for renewing or terminating a person’s coverage even if they forfeit the FMAP increase. The Senate should also require accountability and transparency from states that are willing to forfeit the additional FMAP dollars to resume disenrollment earlier than April 2022.
The Biden administration must also enforce current Medicaid policies designed to reduce red tape for Medicaid beneficiaries. These kinds of ridiculous and burdensome paperwork rules often cause eligible individuals to lose coverage. Specifically, UnidosUS has asked the Biden administration to enforce current statute and regulations which require states to utilize third-party data sources when verifying eligibility during renewal to reduce the amount of paper verification (like check stubs) that families must provide. In addition, CMS must ensure states provide adequate time for families to provide paper verification when third-party data is unavailable.
Keeping eligible children enrolled in Medicaid in 2022 and beyond is essential to narrowing disparities for Latino children and their families and the long-term healing as a nation from the costs of the pandemic. UnidosUS is calling on the Congress and the administration to take these minimum steps to prevent large losses of Medicaid coverage in 2022 that would only deepen health and economic disparities between Latinos and non-Latinos.