Children’s Health Coverage On The Decline

By Consumers For Quality Care, on November 5, 2019

Nine-month-old Elijah’s lips were turning blue as his mother, Kristin Johnson, rushed him to a Houston area emergency room. In the hospital, doctors diagnosed Elijah with a respiratory virus and Johnson learned that her son had been dropped from his Medicaid coverage, The New York Times reports. This was not the first time that Johnson had encountered the issue. Two of her other children had lost their coverage two years prior, and she was so stymied trying to prove their Medicaid eligibility that she eventually gave up.

“I’ve been on this emotional roller coaster,” Ms. Johnson, 34, said of Elijah’s loss of coverage, an error that happened apparently because she didn’t respond quickly enough to a letter asking for new proof of income. “It’s been a very scary month.”

Children losing their coverage is a growing phenomenon. More than a million children, or about three percent, disappeared from the rolls of the nation’s two largest state-federal health care programs, Medicaid and the Children’s Health Insurance Program (CHIP), between December 2017 and June 2019. According to an analysis by The Times, it is not just children enrolled in Medicaid or CHIP that are losing coverage. After decades of overall decreases, the rates of uninsured children rose by more than 400,000 between 2016 and 2018.

[T]here is growing evidence that administrative changes aimed at fighting fraud and waste … are pushing large numbers of children out of the programs, and that many of them are now going without coverage. The declines are concentrated in a minority of states; in other places, public coverage has actually increased.

When asked about the enrollment changes, government officials point to lower unemployment, strong job markets, and wage growth allowing more consumers, and their children, to be covered by private insurance. However, census data shows that the rate of uninsured children is, in some cases, rising in the states with decreasing Medicaid and CHIP enrollment, like Texas, Tennessee, Idaho and Utah.

Texas, like some of the other highly-concentrated states, recently increased requirements for checking on an enrollees’ eligibility. Texas began enrolling children for six months, instead of a year, and then checking their eligibility for four consecutive months. If the families were found to have exceeded the income limit for eligibility, they only had 10 days to prove otherwise to Medicaid. Other states encountered errors when moving enrollees to a new computer system and have lost more since.

Some experts believe that the changes states have made made it more difficult for families to stay on the assistance programs. Historically, when consumers must provide more paperwork for eligibility, fewer consumers receive benefits.

“The way they are doing this seems clearly designed to throw people off this program,” said Eliot Fishman, a senior director at the consumer group Families USA, who was a top Medicaid official in the Obama administration.

After Elijah’s hospitalization, Johnson met with an enrollment counselor to try and understand what had happened. She was able to get all three children re-enrolled in the program and believes that missing the 10-day window to provide her proof of income caused the enrollment issue.

Now, however, she faces a new problem. Johnson has started receiving thousands of dollars in bills from Elijah’s hospitalization. She is hoping that Medicaid will cover these bills retroactively.

And she is haunted by what might have happened if the hospital where she took Elijah had considered the case nonurgent and turned them away.

“I went to the E.R. thinking he had insurance,” she said. “If the receptionist had not seen him turning blue, she might have just said, ‘He’s not covered, so we can’t see him today.’ I do think about that.”