Biden-Harris Administration Releases New Medicaid and CHIP Renewal Data Shows Role of State Policy Choices in Keeping Kids Covered

Said Sec. Becerra Calls on the Nine States with the Highest Child Disenrollment to Immediately Take Tested Federal Flexibilities to Protect Children and Families; The Biden-Harris Administration Extends Federal Flexibilities to States Through the End of 2024

Today, the US Department of Health and Human Services (HHS) released new data on state Medicaid and Childrens Health Insurance Program (CHIP) enrollment changes among children and youth since the full renewal of the eligibility for these programs earlier this year. Data released today make clear that state policy choices have real consequences for children and families during Medicaid and CHIP renewals. States that use proven flexibilities and approaches from the Centers for Medicare & Medicaid Services (CMS) are better able to protect children’s coverage especially when the state also expands Medicaid.

According to the data:

  • States that used more than the federal approaches provided by CMS and prioritized auto-renewals (ex parte) to reduce red tape for families helped more eligible children renew Medicaid and CHIP coverage. Many of CMS’ flexibilities make it easier for states to renew eligible children’s coverage by using data the state already has.
  • Barriers to coverage, such as not expanding Medicaid, lead children and youth to fall through the cracks. For example, the 10 states that did not expand Medicaid Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming disenrolled more children than those that expanded combined. In non-expansion states, youth who turn 19 while the continuous enrollment condition is in place are at risk of falling into the coverage gap and becoming uninsured; these youth on average accounted for 27.6% of disenrollments among children in non-expansion states as of March 2023, compared to 12.1% of disenrollments in expansion states.
  • More than 88 million people, including nearly 40 million children and youth, were enrolled in Medicaid and CHIP coverage in September 2023. Before the pandemic, in February 2020, about 71 million people were enrolled in Medicaid and CHIP , including approximately 35 million children .

Because of this data, CMS issued new comprehensive guidance to states on strategies to protect Medicaid and CHIP coverage for children during this return to regular Medicaid and CHIP renewals. The guidance also announced the extension of these federal strategies for the states until the end of 2024.

Secretary Becerra also sent letters to the governors of the nine states with the highest child disenrollment rates by number and percentage, urging them to adopt additional federal strategies and flexibilities to help prevent children from and their families to lose coverage due to red tape. Those states include Arkansas*, Florida*, Georgia*, Idaho*, Montana*, New Hampshire*, Ohio*, South Dakota*, and Texas*. These nine states accounted for about 60% of the decline in children’s Medicaid and CHIP enrollment from March to September 2023, according to today’s data release. This is especially important for children and families of color who are likely to be least affected.

I urge you to ensure that no eligible child in your state loses health insurance because of red tape or other bureaucratic hurdles during the Medicaid enrollment process, said Secretary Becerra.

Because children’s eligibility thresholds are generally higher than for adults, many children who are disenrolled may still meet important Medicaid eligibility requirements or CHIP underscores the need for states to take additional action to prevent eligible children from falling through the cracks. In his letter, Secretary Becerra called on governors to:

  • Adopt dozens of federal flexibilities and strategies developed to make renewals easier for children and families, including using guidance and tools published by CMS today;
  • Remove barriers, such as CHIP enrollment fees and premiums, that make it difficult for children to transition into CHIP coverage if they are no longer eligible for Medicaid;
  • Reach more families by reducing call center wait times and partnering with pediatric providers, managed care plans, schools, and community organizations; and
  • Expand their Medicaid programs, if states have not already done so, to ensure that young adults over the age of 18 have affordable coverage options and do not fall into the coverage gap.

The actions taken today reflect HHS’s continued commitment to helping people access comprehensive, high-quality health coverage, whether through Medicaid, CHIP, the Health Insurance Marketplaces, Medicare, or a employer. To date, HHS, through CMS, has provided extensive guidance to states on federal Medicaid and CHIP renewal requirements, approving nearly 400 flexibilities for states to make it easier renewals for people, made a special enrollment period available on to help individuals who are no longer eligible for Medicaid transition into Marketplace coverage, contacted stakeholders throughout the public and private sectors, and conducted extensive outreach and advertising efforts to improve awareness about returning to regular Medicaid and CHIP renewals. HHS will continue to monitor state renewal efforts to ensure their compliance with federal Medicaid renewal requirements and will not hesitate to take action where it identifies issues of noncompliance.

CMS is doing everything we can to protect access to health coverage during the Medicaid and CHIP renewal process, especially for children, said CMS Administrator Chiquita Brooks-LaSure. That’s why we’ve filed dozens of strategies for states to protect the ability of children and families to stay covered. Many states have worked with us to adopt the strategies we have put on the table and we strongly urge all states to do their part to ensure that eligible children maintain the coverage they need to grow and thrive.

In addition to releasing this data on children and youth, CMS is releasing a CMS Informational Bulletin that highlights steps states can take to help keep eligible children enrolled in Medicaid and CHIP and announced for the first time that (e)(14) flexibilities will be available at least through the end of 2024, giving states more opportunity to use these strategies; new guidance to support transitions to other forms of coverage, including from Medicaid to CHIP and additional guidance to help states adopt CMS strategies and flexibility to promote continuity of coverage; and data describing other enrollment trends during renewals, including trends related to enrollment in the Health Insurance Marketplace.

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