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Millions of Children on Medicaid at Risk of Losing Coverage

More than 6.7 million children are at risk of losing insurance coverage once pandemic-era restrictions on Medicaid income eligibility checks are lifted on April 1, according to a report by the Georgetown Center for Children and Families.

Legislation enacted early in the pandemic in 2020 temporarily increased federal funding for state Medicaid programs under the condition that states continuously cover beneficiaries until the end of the public health emergency. The ranks of Medicaid beneficiaries grew by nearly 20 million people as the program acted as a health insurance safety net. However, the Consolidated Appropriations Act of 2023 slowly unwinds the federal continuous coverage requirement through May 2024, allowing states to start eligibility redeterminations next month for all 83.5 million Medicaid beneficiaries—including more than 34.2 million children.

To protect children in low-income families, the Consolidated Appropriations Act requires states to provide 12 months of continuous Medicaid and Children’s Health Insurance Program eligibility to children under 19 beginning Jan. 1, 2024, if they don’t already do so. Most states have some form of continuous eligibility for children to protect them from losing coverage during redeterminations of their parents’ eligibility, but 17 states and the District of Columbia do not have such a provision, the Georgetown center found.

Redeterminations require beneficiaries to reapply for health insurance, verifying their income and ensuring that they meet all the other eligibility criteria to continue to receive benefits. However, the process can be complicated and take up to 14 months, and families who fail to complete it on time may lose coverage.

The impact of redeterminations on children’s health-care access concerns many Medicaid stakeholders across the country. Eligibility checks have traditionally caused coverage losses due to bureaucratic roadblocks, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a nonpartisan research and policy institute.

“Historically, we lose a lot of people during the renewal. Recipients are often sent a form by mail to the last known address, which may have changed. Some people might not get the notice they got a renewal in the mail. Others might not act timely because they have very complex situations and may not respond in time. Some might not even understand the notices that they are getting. They’re historically very confusing,” she said.

Public policy advocates also fear that chronic staffing shortages will cause state Medicaid agencies to face backlogs in processing redetermination applications, leading to more unintended policy cancellations.

survey by the National Association of Medicaid Directors found that over a fifth of all state Medicaid agencies have job vacancy rates of over 20%, with some states seeing up to 40%.

The problem is nationwide, even in well-funded states like California, which invested $146 million into its unwinding strategy, stakeholders say. California has done little to rectify the chronic shortages in front-line Medicaid workers in its 58 counties, David Kane, senior attorney at the Western Center of Law & Poverty, said.

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