At least 2 million children lost Medicaid insurance in 2023. Joan Alker, the executive director and co-founder of the Center for Children and Families at Georgetown University, spoke to NPF Future of the American Child fellows about what they should look for when covering the unwinding of Medicaid coverage – especially for children.
“Medicaid absolutely is of disproportionate importance for families of color. It’s important for all children, but it is definitely disproportionately important for children of color,” Alker said, adding that those who identify as Hispanic or Latino have higher uninsured rates.
During the pandemic, states were not allowed to cut anybody off Medicaid, she said. In fact, the number of children on Medicaid went up – from 49% to 54%. But in March 2023, states were allowed to dis-enroll people.
“There are some states that are extremely politically motivated and being pushed to kick people off as quickly as possible,” Alker said.
Texas, California and Florida have the largest decrease in Medicaid enrollment.
Alker encourages journalists to look at Georgetown University’s Center for Children and Families Medicaid enrollment data to view specific numbers per state.
“We expected a lot of this to happen, but unfortunately nationwide about 70% of these dis-enrollments are what we call procedural losses. They’re not due to finding of ineligibility. So, this is a really big deal.”
Alker said procedural termination means that the person or the family did not complete the process. States are supposed to start with the ex parte process and keep families on if they can without them having to reprove them. However, some states, like Texas, have weak parte processes. Alker said that, in her opinion, those states are “violating the federal law.” For families that fail the process, the state sends a form to the family, which they need to fill out and send back. But that can lead to issues.
“Okay, so sounds good. But you can imagine how many millions of things could go wrong in that process. Starting with return mail. As we discussed, many families moved, (the) state may not have the right address. So right off the bat is a big issue. Family gets the letter and it’s extremely confusing. The notices are very hard to figure out.”
A lot of the children who are losing Medicaid are still eligible, said Alker. The eligibility levels for Medicaid and CHIP together is a median of 250% of the poverty level across the country. Look at where the children are going – whether it’s employer-sponsored coverage or the CHIP program.
“When you hear elected officials and policymakers talking about something, especially when it comes to health coverage, you have to say, ‘Are you talking about the adult or the child?’ Because a lot of times children have a different coverage source than their parents, particularly when they’re in public coverage. And this honestly was just glossed over for a year.”
Alker tells journalists to also ask about how the quality of care is being delivered in their state. “If we could get stability in the coverage, we could start to unpack this question of how is care being delivered, which is absolutely critical.”
Access the full transcript here.
This fellowship is funded by the David and Lucile Packard Foundation, the W.K. Kellogg Foundation and the Heising-Simons Foundation. NPF is solely responsible for programming and content.
