New Report: Texas and Florida at highest risk of eligible children losing Medicaid

By Melissa McChesney, Health Policy Advisor, UnidosUS

The end of the public health emergency and the continuous coverage requirement could mean the largest single year loss of health coverage by children in history. A deeply troubling new report from the Center for Children and Families at Georgetown University estimates that at least 6.7 million children—including 2.4 million Latino children—are at risk of losing coverage in 2022 when the Medicaid continuous coverage requirement is lifted.

As we previously identified, more than half of Latino children depend on Medicaid coverage. Simply put, it would be unacceptable to emerge from the pandemic by losing coverage for 2.4 million Latino kids, and this result would tragically further deepen existing racial and ethnic disparities in health care access.

Here’s how this could unfold: when the public health emergency (PHE) ends, states will begin to redetermine Medicaid for all recipients and may terminate coverage. During this process, even children who remain eligible for health coverage could lose it in a couple of ways:

• First, a child could actually be eligible for Medicaid but could lose coverage for a missing a step in the renewal process. Such missed steps are common and can include situations in which a parent does not respond right away to a mailed request for information, or even when that request is mailed to the wrong address or similar “paperwork” reasons.
• Second, some children may not be eligible to continue on Medicaid but could be eligible for another public coverage program, such as the Child Health Insurance Program (CHIP), but they would still need to be signed up for that program.

According to the new report, key aspects of how states implement both Medicaid and programs like CHIP will make a critical difference in the number of eligible children who will become uninsured, thus impacting millions of kids. And there are big differences among the states: states with enrollment and retention policies that promote coverage are far more likely to see fewer eligible kids kicked off coverage for procedural reasons.

But some state policies appear designed to do the opposite, creating landmines for families that encourage a slide from coverage. Florida and Texas—two states with some of the highest numbers of Latino children on Medicaid in the country—are among those named in the report as places in which kids are most likely to lose coverage due to harmful state policies.* These impacts are devastating for health equity, and for preventing higher health care costs for uninsured kids (and the taxpayers and families on the hook for those costs). And their implications for Latinos are significant, as 54% of the 3.7 million kids in the Texas’ Children’s Medicaid program are Latino.**

It’s not too late to head off this public health disaster. The governors and state Medicaid agencies in Florida and Texas must act now to prioritize the health of children and minimize the number of kids who will lose health care coverage.

There are some steps that states can and should take. First, Florida and Texas should make its transition plan and related data public, as this is the plan for the end of the PHE that best explains how the state will transition to the post-pandemic era. It’s important for these plans to minimize coverage loss. The following are examples of how states can improve retention at the end of the PHE:

• Increase the state’s use of third-party data to identify address changes and process renewals. States that fully leverage third-party data can increase the number of renewals processed without action from clients. This improves retention of eligible individuals in the program and reduces workloads for agency staff.

• Stagger processing redeterminations to avoid overloading an already strained system. CMS guidance suggests that states process no more than one-ninth of the total caseload in any given month and allows states to take up to 14 months to finish processing new redetermination after the PHE ends.

• Ensure the agency has the workforce capacity to handle increased demand. State agencies, like many other industries, are facing a workforce shortage. Agencies should be planning now to increase staff resources in anticipation of the increase in work that will come at the end of the PHE.

• Create outreach plans to let clients know the changes are coming and what they should do. As suggested in the CCF report, states can utilize available CHIP administrative funding to pay for additional outreach. Currently, only two states report administrative expenditures in their CHIP programs that come close to the required 10% cap.

• Track outcomes and intervene quickly if eligible children begin to lose coverage and end up uninsured. CMS will require each state to submit monthly reports in the 14 months after the PHE ends. The goal is to track the state’s progress in returning to normal and to quickly identify compliance issues including erroneous denials of eligible individuals.

As the country continues to battle the impact of the COVID-19 pandemic, protecting coverage for children must be a top priority. Even small gaps in coverage can lead to interruptions in access to vaccines, medications, therapies, and other medical treatments. Delayed or skipped treatment often leads to worsening conditions and greater use of high-cost care.

But state leaders can help to protect the health and well-being of children. We call on state leaders in Florida, Texas, and around the country to rise to this challenge and put the health of children above politics and call on advocates to hold them accountable to the above clear list of action items that can help save coverage for kids.

* States with the following policies are at highest risk of children losing coverage: separate CHIP programs, premiums or enrollment fees for CHIP, do not provide 12 months of continuous coverage for children in Medicaid, and processing less than half of renewals using existing data sources and without client needing to take action. States with all five factors are Delaware, Florida, Georgia, Missouri, Nevada, and Texas.

** UnidosUS analysis of data from the Texas Health and Human Service commission.