Why Some Children Could Lose Medicaid Coverage After COVID-19

A group of pre-teen kids, smiling

More people than at any time in American history have health insurance through Medicaid and the related Children’s Health Insurance Program (CHIP). And millions are likely to lose this coverage – designed for people with low incomes and/or disabilities – when the COVID-19 pandemic comes to an end.

The loss of coverage will come through “redetermination,” a regular process under federal law. It ensures that people who are covered by a state’s Medicaid program meet eligibility requirements. If a person or family has begun to earn too much money to qualify, or if they move out of state, they are removed from the Medicaid rolls.

Redetermination is usually annual, but it hasn’t happened since early 2020 because of the declared public health emergency. The federal government has provided extra Medicaid funding for states, and in turn, states have not removed people from Medicaid rolls. At the same time, the pandemic has created economic hardships for some, making them newly eligible for this federal insurance program.

By one well-regarded estimate from the Kaiser Family Foundation, there are 25% more people covered by Medicaid right now than there were at the beginning of the pandemic. There are 572,000 more in Ohio alone, according to the Ohio Department of Medicaid.

The Kaiser Family Foundation also estimates that between 5.3 million and 14.2 million people will lose their coverage during redetermination. Some of those will be children. Perhaps thousands in Ohio, and millions across the country.

“In many cases, it will be appropriate for these young people and families to no longer be covered by Medicaid,” says Mary Siefke, CPA, director of Finance and Medical Economics at Partners For Kids. “If their economic situations have improved, they may not qualify anymore. But there is some worry that children who should remain covered may inadvertently lose their health insurance in the process.”

Partners For Kids is one of the oldest and largest pediatric accountable care organizations in the United States, working with Medicaid managed care plans and providers to help approximately 480,000 children in Ohio receive the care they need. Started by Nationwide Children’s Hospital, it now also partners with Dayton Children’s Hospital and more than 1,000 providers in delivering that care.

Many of Ohio’s children covered by Medicaid are expected to be redetermined automatically, using documentation that already exists; if a child or family has been deemed eligible for certain other benefit programs, for example, that can be used as proof that they are also eligible for Medicaid. In those cases, a child and family have to do nothing to keep this insurance coverage.

When that automatic redetermination isn’t possible, people who are currently covered by Medicaid will receive a packet by mail, which they can use to prove their eligibility. But changes in address could mean that families won’t receive the packet. If they don’t understand that they must actively prove their eligibility, they may inadvertently lose Medicaid coverage.

And there’s an added time pressure in Ohio. The federal Centers for Medicare and Medicaid are allowing up to 14 months for this redetermination process to take place after the end of the public health emergency. The Ohio budget allows only 90 days.

What remains unknown is when the public health emergency will end. President Joe Biden’s administration has pledged to give states 60 days’ notice, and that notice has not come yet.